title: Systematic review: does endocrine therapy prolong survival in patients with prostate cancer?
abstract: Objective Primary androgen deprivation therapy (ADT) remains the gold standard in the management of patients with advanced prostate cancer (PCa). ADT relieves symptoms and reduces tumor burden, but it has never been demonstrated to increase either PCa-specific or overall survival per se. Several trials have challenged this dogma. The aim of this study was to evaluate how endocrine therapy (ET) affects survival in different clinical settings of PCa. Materials and methods A review of published phase II, III and IV studies evaluating the effect of ET on survival was performed. Results In localized and locally advanced non-metastatic PCa, neoadjuvant ET before radical prostatectomy has no effect on survival. Neoadjuvant and adjuvant ET in combination with curatively intended radiotherapy results in PCa-specific and overall survival benefit, although the duration of ET remains under debate. In N + disease, the timing of ET is under debate, although data suggest that early ET is associated with decreased PCa-specific and overall mortality. In M + disease, no proper randomized trials have been performed in patients with newly diagnosed M1 disease. In metastatic castration-resistant PCa, two novel endocrine agents have been proven to increase overall survival significantly compared to placebo. Conclusions ET has never been proven to increase survival in newly diagnosed metastatic PCa in a randomized clinical trial. Nonetheless, a number of trials supports that ET with proper timing, sequencing and in combination with other therapeutic modalities increases survival in several stages of PCa.
authors.affiliation: a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet , Copenhagen University Hospital, Faculty of Health and Medical Sciences , Copenhagen , Denmark.
authors.forename: John Thomas
authors.initials: JT
authors.lastname: Helgstrand
authors.affiliation: a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet , Copenhagen University Hospital, Faculty of Health and Medical Sciences , Copenhagen , Denmark.
authors.forename: Kasper Drimer
authors.initials: KD
authors.lastname: Berg
authors.affiliation: a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet , Copenhagen University Hospital, Faculty of Health and Medical Sciences , Copenhagen , Denmark.
authors.forename: Solvej
authors.initials: S
authors.lastname: Lippert
authors.affiliation: a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet , Copenhagen University Hospital, Faculty of Health and Medical Sciences , Copenhagen , Denmark.
authors.forename: Klaus
authors.initials: K
authors.lastname: Brasso
authors.affiliation: a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet , Copenhagen University Hospital, Faculty of Health and Medical Sciences , Copenhagen , Denmark.
authors.forename: Martin Andreas
authors.initials: MA
authors.lastname: Røder
mesh_terms: D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000628:therapy*; D015996:Survival Rate
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal
keywords: ADT; androgen suppression; endocrine therapy; prostate cancer; survival; systematic review