Table of Contents

Chapter 6: Using Hormone Therapy

i. Neoadjuvant Hormone Therapy

In women with breast cancer, the purpose of neoadjuvant therapy (neo, meaning before; adjuvant, meaning as an adjunct to) is to shrink the tumor so that a breast conserving surgery, or lumpectomy, can be performed. Typically, a course of just a few months of therapy is enough to accomplish this goal. This treatment might also be sufficient to eliminate microscopic disease that may be present elsewhere in the body but too small to be detected by any scan.

Results from clinical trials that have looked at the benefits of neoadjuvant hormone therapy in men undergoing primary radiation therapy have shown improved outcomes with its use, but there doesn’t seem to be much benefit for men undergoing prostatectomy.

Why there would be a difference between the two remains unclear but two main theories have been proposed. First, the hormone therapy weakens the cancer cells in the prostate, making them more sensitive to radiation. Second,the hormone therapy might eradicate hidden metastatic disease elsewhere in the body in men with more aggressive cancers, particularly those with Gleason scores above 7.

The boost that neoadjuvant hormone therapy gives to the success of radiation therapy has resulted in the approach becoming the standard of care in many institutions for men with high-grade cancers and/or those with larger, bulkier tumors.

In this setting, LHRH agonists, antiandrogens, or a combination of the two are given for three to six months, after which the radiation therapy begins.

When reviewing the different treatment options, be sure to discuss with your doctors whether a short course of neoadjuvant hormone therapy before radiation therapy might be right for you, and whether continuing the hormones afterwards might be beneficial.