title: Neoadjuvant androgen ablation in localized carcinoma of the prostate.
abstract: BACKGROUND
  An increased awareness of prostate cancer has led to a rise in the detection of this disease at a clinically localized stage at presentation. This article discusses the role of neoadjuvant hormonal ablation at this earlier stage to decrease tumor bulk and thus enhance survival.
  
  
  METHODS
  Outcomes from each primary modality for localized treatment of prostate cancer with and without neoadjuvant androgen deprivation (NAAD) are reviewed.
  
  
  RESULTS
  Survival benefit using NAAD has not yet been demonstrated from prostatectomy. Long-term hormonal deprivation provides an improved time to progression and has decreased distant metastatic and biochemical failure for poor-risk patients undergoing external-beam radiation. The toxicities of brachytherapy can be decreased with NAAD.
  
  
  CONCLUSIONS
  NAAD with radical prostatectomy is considered to be investigational. The duration of NAAD needs to be delineated for poor-prognosis patients who are treated with external-beam radiation therapy, but the approach improves the local toxicity of brachytherapy.
authors.affiliation: Genitourinary Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, MCC-UROPROG, 12902 Magnolia Drive, Tampa, FL 33612, USA. KishJA@moffitt.usf.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Kish
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001706:Biopsy; D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal