Med. J. Cairo Univ., Vol. 80, No. 1, December: 903-907, 2012 www.medicaljournalofcairouniversity.com Neoadjuvant Hormonal Therapy Versus Radiotherapy Alone in Treatment of Locally Advanced Prostate Cancer MAHER EDAROS, M.D.*; NASHWA NAWAR, M.D.*; MOHAMMED A. BADAWY, M.D.*; AHMED M. ELIWA, M.D.**; HAZEM ELGALALY, M.D.** and SALEM KHALIL, M.D.** The Departments of Clinical Oncology & Nuclear Medicine* and Urology**, Faculty of Medicine, Zagazig University Abstract Introduction: Despite adequate local therapy for carcinoma of the prostate, significant proportion of patients developed a progressive or metastatic disease. Neoadjuvant hormonal therapy not only provides possible early systemic treatment for a subclinical disease, but may also help in improving local disease control by increasing the number of patients eligible for definitive local therapy (via down staging). Objective: To compare neoadjuvant hormonal therapy before definitive radiotherapy and radiotherapy alone in treatment of locally advanced prostate cancer. Patients and Methods: We retrospectively compared the oncologic outcome of neoadjuvant hormonal therapy before radical radiotherapy versus radical radiotherapy alone in patients with locally advanced prostatic cancer (T3-T4, Nx, M0) treated between June 2004 and September 2007. Thirty seven patients were included in the study as two groups; group I included 19 patients treated with neoadjuvant hormonal therapy before and during radical radiotherapy (LHRH ana- logue for four months with added flutamide in the 1 st month), and group II included 18 patients treated by radical radiotherapy alone. The dose of radiation therapy was 70G (44G to the whole pelvis and 26 G to the prostate and seminal vesicle). Patients were followed for a minimum of 5 years. Follow-up included serum PSA, and TRUS performed three months after therapy. Five-year survival and biochemical-disease-free survival were calculated foe both treatment groups. Results: The mean patient age was (71.3 y) and (69.7 y) for group I and II respectively. Mean pretreatment PSA was 37.1 ng/ml in group, I and 39.5 ng/ml in group II. Twenty six patients (70.2%) were T3 [group, I (12 patients) and group II (14 patients)] while 11 patients (29.8%) were T4 [group, I (6 patients) and group II (5 patients)]. The Mean follow-up was 61.5 months in group, I and 68 months in group II. There was significant reduction in prostate volume in group, I with a reduction ratio of 25.5% while in group II volume reduction was insignificant. Eleven patients (29.73%) died due to tumor progression, four (10.81%) in group I and seven (18.91%) in group II. Five-year survival rate was 80% in group, I compared to 52.5% in group II. Additionally 5-years biochemical disease- Correspondence to: Dr. Maher Edaros, The Department of Clinical Oncology & Nuclear Medicine, Faculty of Medicine, Zagazig University free survival was 79% in group, I compared to 57% in group II. The time to PSA nadir was earlier in group, I compared to group II (11.2Vs 19.2 months). Conclusion: Neoadjuvant hormonal therapy combined with radiotherapy showed benefits in terms of 5-year overall survival, biochemical disease-free survival and time to PSA nadir compared to radiotherapy alone. Prospective randomized trial is needed to recommend optimal course, dose and patient selection criteria. Key Words: Radiotherapy – Cancer prostate – Neoadjuvant – Hormonal therapy. Introduction PROSTATIC carcinoma is the most common cancer among men in the United States, and it is potentially a curable disease in patients with local- ized disease, radical prostatectomy or radiotherapy may definitively eradicate all disease, resulting in overall survival of approximately 75% [1] . Accord- ing to the national cancer institute (Cairo University, Egypt) cancer pathology registry during years 2003 and 2004 showed an incidence of 49-95.7% of prostatic carcinoma and prostatic tumors respec- tively among male genital tract tumors [2] . The reported prevalence of prostate cancer in Egypt is 8.5% [3] . In developed countries the increasing use of PSA as screening tool, diagnosis of prostate cancer has progressed toward early stage detection [4] , but in Egypt locally advanced and even metastatic disease are still the first ongoing clinical presenta- tion. Despite adequate local therapy as radical prostatectomy or radiotherapy, significant propor- tion of patients develops progressive or metastatic disease 15-40% [5] . Hormonal therapy plays a major role in the treatment of advanced prostatic cancer, and it has been studied extensively in the neoadjuvant setting. 903