Abstract

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• Risk categorization based on pre-treatment PSA, clinical stage and Gleason score is now widely used in the management of patients with localized prostate cancer. In patients with low-risk disease (cT1-T2a, PSA < 10 ng/ml and Gleason score < 6) there is no role for the routine use of adjunctive hormonal therapy. In intermediate-risk patients (T1-T2, PSA < 20 ng/ml and Gleason ≤ 7) there is some evidence to suggest improved outcomes with neo-adjuvant hormonal therapy when low-dose external beam radiation therapy (EBRT) is used. However, with appropriate modern dose EBRT there is little data to support the use of routine adjunctive hormonal therapy and this should be done only in the context of a clinical trial.