title: Hormone and radiotherapy versus hormone or radiotherapy alone for non-metastatic prostate cancer: a systematic review with meta-analyses.
abstract: OBJECTIVE
  Radiotherapy is standard treatment for localised prostate cancer and is often combined with hormone treatment to prevent androgen stimulation of prostate cancer. Hormone therapy carries significant morbidity and can only be justified in the radical treatment of localised disease if it can be balanced against a significant gain in disease control and survival.
  
  
  METHODS
  We searched Medline, Premedline, Embase, Cochrane Library, Web of Science (SCI & SSCI) and Biomed Central for randomised controlled trials published in English comparing radiotherapy or hormone therapy alone with radiotherapy and hormone therapy in combination as first-line treatment in patients with non-metastatic prostate cancer reporting overall survival, disease-free survival, distant metastases-free survival, biochemical survival, adverse events (including cardiovascular) and/or health-related quality of life.
  
  
  RESULTS
  Fourteen trials were included and showed that combination therapy was associated with better or similar survival and disease-free outcomes compared with single-modality treatment, and that this may particularly be the case for patients with higher risk disease. The results also suggested that combination therapy is associated with more and worse adverse events and quality of life, although this was not always the case. Some of the results are at risk of reporting bias.
  
  
  CONCLUSIONS
  The published data support the use of combined treatment with androgen deprivation and radiotherapy for intermediate- and high-risk localised and locally advanced prostate cancer. Optimal timing, duration, formulation and the management of side-effects remain important questions for further research.
authors: National Collaborating Centre for Cancer, Cardiff, UK. Electronic address: Mia.Schmidt-Hansen@wales.nhs.uk.
authors: M
authors: M
authors: Schmidt-Hansen
authors: Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
authors: P
authors: P
authors: Hoskin
authors: The Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK.
authors: P
authors: P
authors: Kirkbride
authors: National Collaborating Centre for Cancer, Cardiff, UK.
authors: E
authors: E
authors: Hasler
authors: National Collaborating Centre for Cancer, Cardiff, UK.
authors: N
authors: N
authors: Bromham
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D006801:Humans; D008297:Male; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D011878:Radiotherapy
chemical_list: D000726:Androgen Antagonists
keywords: First-line treatment; hormone therapy; locally advanced; prostate cancer; prostate neoplasm; radiotherapy