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Adjuvant goserelin improves clinical disease‐free survival and reduces disease‐related mortality in patients with locally advanced or localized prostate cancer

This article reviews the clinical disease‐free survival (DFS) and disease‐related mortality (DRM) data from published prospective, randomized trials of goserelin, given alone as adjuvant treatment or combined with a nonsteroidal antiandrogen as neoadjuvant treatment in patients with locally advanced or localized prostate cancer. Four trials were of radiotherapy and one of radical prostatectomy. The five trials included > 3500 patients and the median follow‐up was 4.8–7.1 years. There were statistically significant improvements in clinical DFS with goserelin support relative to the control treatment in all five trials (each log‐rank P ≤ 0.004). Reductions in the risk of DRM were statistically significant with adjuvant goserelin vs no adjuvant treatment to support radiotherapy in one trial, and with adjuvant goserelin or bilateral orchidectomy vs no adjuvant treatment to support radical prostatectomy in another (each log‐rank P ≤ 0.001). Time‐point estimates of the rates of clinical DFS and DRM were in favour of goserelin support vs control in all five trials at 5 years and in the three trials for which data were available at 8 years. Goserelin support therefore improves clinical DFS and reduces DRM after radiotherapy or radical prostatectomy. Adjuvant goserelin may offer greater clinical benefits than neoadjuvant hormonal treatment.