Early vs. Delayed Hormonal Treatment in Locally Advanced orAsymptomatic Metastatic Prostatic Cancer Patient Dilemma: A Review

Introduction: Hormonal therapy for prostate cancer has been used for more than 60 years in patient. Whether immediate or deferred hormonal treatment is best for patients with locally advanced prostate cancer (LAPC) and/or or asymptomatic metastasis who are not suitable for curative local treatment of prostate cancer has been debated since its introduction. The objective of this work is to compare the effectiveness of hormonal treatment as an early or as a deferred intervention for patients with (LAPC) and/or asymptomatic metastasis. Materials and methods: Systematic review and meta-analysis of trials published during 1950 to 2011. Results: We retrieved 22 articles for detailed review, of which 8 met inclusion criteria. The Veterans Administration Cooperative Urological Research Group (VACURG) suggested that delaying hormonal therapy did not compromise overall survival and that many of the patients died of causes other than prostate cancer. In the European Organization for Research and Treatment of Cancer (EORTC) 30846 trial the median survival for delayed endocrine treatment was 6.1 yr and for immediate treatment 7.6 yr, the HR for survival on delayed vs immediate treatment was 1.23 (95% CI 0.88 to 1.71), indicating a 23% non significant trend in favor of early treatment. In protocol EORTC 30891 the immediate androgen deprivation resulted in a modest but statistically significant increase in overall survival but no significant difference in prostate cancer mortality or symptom-free survival. The protocol SAKK 08/88 showed for elderly, asymptomatic patients not undergoing curative local treatment, the lack of any major advantage of immediate compared with deferred hormonal treatment regarding quality of life or overall survival. Conclusions: The early intervention with hormonal treatment for patients with LAPC provides important reductions in all-cause mortality, prostate cancer-specific mortality, overall progression, and distant progression compared with deferring their use until standard care has failed to halt the disease.