Most prostate cancers need a supply of the male hormones, androgens, to continue their growth. Reducing the levels of androgens in the blood will usually cause prostate cancers to stop growing and actually reduce in size. So, giving treatments which reduce androgen levels can be an effective way of controlling prostate cancer. Eventually, however, the cancer will escape from this control and begin to grow again, although it may be some years before this happens.

A number of clinical trials have now been carried out to see whether giving tablets or injections which reduce androgen levels (a treatment known as androgen ablation ) for 3 to 6 months before a radical prostatectomy will shrink the size of the tumour, make the operation easier, reduce the risk of the cancer coming back and improve the chance of cure. This idea of giving a period of drug treatment to try and shrink the cancer before surgery is known as neoadjuvant therapy.

The evidence so far is that using neoadjuvant androgen ablation does often reduce the size of the tumour before surgery. But it is too soon to know whether this apparent benefit does actually lead to an increased chance of cure and extend life-expectancy. More recently studies where androgen ablation treatment has been continued after surgery (this is sometimes called adjuvant therapy) have suggested that there may be a long term benefit but more time is needed for this to be confirmed.

Because of this uncertainty, at the present time some surgeons suggest neoadjuvant and/or adjuvant androgen ablation routinely for all their patients whilst others recommend it only for men whom they feel have a greater risk of the cancer coming back after their operation. Things which some specialist think might suggest such an increased risk include:

• a PSA level greater than 20
• a high Gleason score, of 8 to 10
• evidence on CT or MRI scans suggesting that the tumour might have spread to nearby lymph glands in the pelvis

As more results come out from the various trials the place of neoadjuvant and adjuvant androgen ablation in the care of men with prostate cancer will become clearer and doctors will have a better idea of just who is likely, or not likely, to benefit from this type of treatment.