title: Role of Hormonal Treatment in Prostate Cancer Patients with Nonmetastatic Disease Recurrence After Local Curative Treatment: A Systematic Review.
abstract: The relative benefits and harms of hormonal treatment (HT) versus no or deferred HT in patients with nonmetastatic prostate cancer (PCa) relapse after primary curative therapy are controversial.
  
  
  
  To assess the effectiveness of HT for nonmetastatic PCa relapse, prognostic factors for treatment outcome, timing of treatment, and the most effective treatment strategy to provide guidance for clinical practice.
  
  
  
  A systematic literature search was undertaken incorporating Medline, Embase, and the Cochrane Library (search ended March 2015). Studies were critically appraised for risk of bias. The outcomes included overall and cancer-specific survival, metastasis-free survival, symptom-free survival, progression to castrate resistance, adverse events, and quality of life.
  
  
  
  Of 9687 articles identified, 27 studies were eligible for inclusion (2 RCTs, 8 nonrandomised comparative studies, and 17 case series). The results suggest that only a subgroup of patients, especially those with high-risk disease, may benefit from early HT. The main predictors for unfavourable outcomes were shorter PSA doubling time (<6-12 mo) and higher Gleason score (>7). Early HT may be warranted for patients with high-risk disease. An intermittent HT strategy appears feasible. Most studies had a moderate to high risks of bias.
  
  
  
  HT for PCa relapse after primary therapy with curative intent should be reserved for patients at highest risk of progression and with a long life expectancy. The potential benefits of starting HT should be judiciously balanced against the associated harms.
  
  
  
  This article summarises the evidence on the benefits and harms of hormonal treatment in prostate cancer (PCa) patients in whom the disease has recurred following earlier curative treatment. We found that only a select group of patients with aggressive PCa and a fast rising prostate-specific antigen may benefit from early hormonal treatment (HT), whereas in others HT may be more harmful than beneficial.
authors.affiliation: Department of Urology, University Medical Centre, Utrecht, The Netherlands.
authors.forename: Roderick C N
authors.initials: RC
authors.lastname: van den Bergh
authors.affiliation: Department of Urology, Ijsselland Hospital, Capelle aan de Ijssel, The Netherlands.
authors.forename: Niels J
authors.initials: NJ
authors.lastname: van Casteren
authors.affiliation: Department of Urology, University Hospitals, Leuven; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: van den Broeck
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Eve R
authors.initials: ER
authors.lastname: Fordyce
authors.affiliation: Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: William K M
authors.initials: WK
authors.lastname: Gietzmann
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Stewart
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: MacLennan
authors.affiliation: Department of Urology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Saeed
authors.initials: S
authors.lastname: Dabestani
authors.affiliation: Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.affiliation: Department of Radiation Oncology, Centre Hospitalier Universitaire Michallon, Grenoble, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Bolla
authors.affiliation: Hasselt, Belgium.
authors.forename: Erik
authors.initials: E
authors.lastname: Briers
authors.affiliation: Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Cornford
authors.affiliation: Department of Urology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Joniau
authors.affiliation: Velindre Hospital, Cardiff, UK.
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Mason
authors.affiliation: Department of Onco-Urology, Cancer Research Centre, Moscow, Russia.
authors.forename: Vsevolod
authors.initials: V
authors.lastname: Matveev
authors.affiliation: Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Henk G
authors.initials: HG
authors.lastname: van der Poel
authors.affiliation: Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Theo H
authors.initials: TH
authors.lastname: van der Kwast
authors.affiliation: Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Rouvière
authors.affiliation: Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wiegel
authors.affiliation: Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Lam
authors.affiliation: Department of Urology, North Hospital, CHU de Saint-Etienne, University of Jean-Monnet, Saint-Etienne, France. Electronic address: nicolas.mottet@chu-st-etienne.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mottet
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists / Q000037:antagonists & inhibitors; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D009919:Orchiectomy; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000628:therapy*; D016879:Salvage Therapy / Q000379:methods; D013997:Time Factors
chemical_list: D000726:Androgen Antagonists; D004967:Estrogens; D007987:Gonadotropin-Releasing Hormone; D017430:Prostate-Specific Antigen
keywords: Curative treatment; EAU; Guidelines; Hormonal; Non-metastatic; Prostate cancer; Recurrence; Systematic review; Therapy