Localized
prostate cancer is generally treated with radical
prostatectomy or
radiation therapy (external beam or brathytherapy). However, the primary treatment failure rate is especially high in so-called high-risk patients. Therefore, many clinical trials of
neoadjuvant therapy before
radiation therapy or
prostatectomy have been conducted. We reviewed randomized controlled studies of
neoadjuvant therapy combined with surgery or
radiotherapy in localized or locally advanced
prostate cancer. In some prospective studies, neoadjuvant
hormones prior to external beam
radiation therapy have been shown to significantly improve disease-free, disease-specific and overall survival as well as to reduce local recurrence or
metastases. By contrast, neoadjuvant hormonal
therapy prior to
prostatectomy did not improve recurrence-free and overall survival, although there was a significant reduction in the
positive surgical margin rates and a significant improvement in other pathological variables such as lymph node involvement, pathological staging and organ confined rates. However, the use of neoadjuvant
hormones for a longer time, either 6 or 8 months prior to
prostatectomy, was associated with a further reduction in
positive surgical margins, and might improve the treatment outcome of the patients. More research is needed to guide patient selection, choice, duration and schedule of hormonal
therapy prior to
radiation therapy or surgery. A large Phase III study of
neoadjuvant chemotherapy using
docetaxel before
prostatectomy is ongoing, and the results of this study are much awaited.