The current status of adjuvant hormonal therapy combined with radiation therapy for localised prostate cancer.

Analysis of the results of treatment of localised prostate cancer with radiation and surgery has identified patients who are at high risk of developing metastatic dissemination. High histologic grade, serum prostate specific antigen above 20 ng/ml, extension beyond the capsule of the prostate, and involvement of lymph nodes are highly predictive of metastatic risk. Antiandrogen therapy has high rates of activity in the treatment of overt metastatic disease prompting its assessment as an adjuvant treatment added to radiation therapy. There are now major prospective randomized trials which have been completed. The current evidence indicates that a large survival benefit ensues when antiandrogen therapy is added to radiation for appropriately selected patients. This adjuvant approach is likely to become the standard of care. Strategies for further enhancement of adjuvant therapy are discussed.