Hormone Therapy After Prostate Surgery: New Study Questions Routine Use

A recent meta-analysis presented at the 2026 American Society of Clinical Oncology Genitourinary Cancers Symposium and published in The Lancet suggests that adding hormone therapy to postoperative radiotherapy may not significantly improve survival for most men following radical prostatectomy. The findings challenge current practices and highlight the necessitate for a more personalized approach to treatment.

Study Details and Methodology

Researchers, led by Dr. Amar U. Kishan of UCLA Health Jonsson Comprehensive Cancer Centre, conducted an individual patient data meta-analysis of six randomized phase III trials. The study pooled data from 6,057 patients who underwent postoperative radiotherapy, with or without hormone therapy, up to December 2024. The primary outcome measured was overall survival.

Key Findings: Overall Survival

The analysis revealed that adding hormone therapy to radiotherapy did not demonstrate a significant improvement in overall survival (hazard ratio [HR] = 0.87, 95% confidence interval [CI] = 0.76–1.01, P = .06). The 10-year overall survival rates were 84.3% for patients receiving hormone therapy in addition to radiotherapy, compared to 83.6% for those receiving radiotherapy alone.

Short-Term vs. Long-Term Hormone Therapy

The study also compared short-term (4–6 months) and long-term (24 months) hormone therapy. Long-term hormone therapy showed a hazard ratio for overall survival of 0.79 (95% CI = 0.63–1.00), while short-term hormone therapy had a hazard ratio of 0.93 (95% CI = 0.77–1.11). Yet, the difference in efficacy between short-term and long-term hormone therapy was not statistically significant (P for interaction = .17).

The Role of PSA Levels

A significant interaction was observed based on pre-radiotherapy prostate-specific antigen (PSA) levels. Among patients with PSA levels greater than 0.5 ng/mL, hormone therapy showed a potential benefit. However, for men with low PSA levels (0.5 ng/mL or less) before radiotherapy, adding hormone therapy – whether short-term or long-term – did not improve overall survival.

Specifically, the upper bounds of the 95% confidence interval for overall survival HR crossed 1.0 for patients receiving short-term hormone therapy. For those receiving long-term hormone therapy, the upper bounds of the 95% CI were below 1.0 at PSA levels greater than 1.6 ng/mL.

Implications and Future Directions

Dr. Kishan emphasized that hormone therapy carries significant side effects, including fatigue, hot flashes, sexual dysfunction, weight gain, bone loss, and increased cardiovascular risk. The study suggests that for many men with detectable but low PSA levels after prostate removal, postoperative radiotherapy alone may be highly effective.

“Our findings…provide the strongest level of evidence to date suggesting there might be no meaningful overall survival benefit to adding hormone therapy, either short-term or long-term hormone therapy, to postoperative radiotherapy for PSA 0.5 ng/mL or less,” Dr. Kishan stated. The researchers call for further investigation to identify biomarkers that can predict which patients are most likely to benefit from hormone therapy.

Key Takeaways

• Adding hormone therapy to postoperative radiotherapy does not improve overall survival for most men after radical prostatectomy.
• Men with low PSA levels (<0.5 ng/mL) before radiotherapy do not appear to benefit from hormone therapy.
• Hormone therapy may offer modest benefits for men with higher PSA levels (>0.5 ng/mL).
• The study highlights the need for a personalized approach to treatment, considering PSA levels and potential side effects.

Disclosure: This study was funded by the National Institutes of Health. Further details on author disclosures can be found at thelancet.com.

Source: Kishan, A. U. Et al. (2026). Adding Hormone Therapy to Postoperative Radiotherapy Confers a Survival Benefit for Patients with Prostate Cancer. The Lancet. https://dailynews.ascopubs.org/do/adding-hormone-therapy-postoperative-radiotherapy-confers-survival-benefit-patients