Multimodal treatment strategies combining neoadjuvant hormonal therapy and/or chemotherapy with radical prostatectomy in high-risk localised prostate cancer.

By combining the readily available clinical parameters of tumour stage, Gleason score of the diagnostic biopsy specimen and serum prostate-specific antigen level, men with newly diagnosed prostate cancer can be assessed as to their risk of treatment failure after radiotherapy or radical prostatectomy. For men considered to be at high-risk of treatment failure after local therapy alone, multimodal treatment strategies may result in improved cancer-control outcomes. This strategy has proven effective in the setting of clinical stage T3 - T4 tumours in which the combination of radiotherapy followed by hormonal therapy has improved patient survival. The benefit of neoadjuvant or adjuvant hormonal and/or chemotherapy followed by radical prostatectomy in this setting is unclear but is the subject of ongoing or planned Phase III clinical trials. These studies will help examine the role of multimodal treatment strategies in these high-risk patients.