Efficacy and Safety of Neoadjuvant Luteinizing Hormone-Releasing Hormone Antagonist and Tegafur-Uracil Chemohormonal Therapy for High-Risk Prostate Cancer

Abstract

Background: This retrospective single-center cohort study evaluated the efficacy and safety of a combination of neoadjuvant luteinizing hormone-releasing hormone (LHRH) antagonist and tegafur-uracil (UFT) therapy (NCHT) and investigated the medical records of patients with high-risk PCa who underwent robot-assisted radical prostatectomy (RARP). The therapy was followed by RARP for high-risk PCa. Materials and Methods: The enrolled patients were divided into two groups: low-intermediate-risk PCa patients who underwent RARP without neoadjuvant therapy (non-high-risk) and those who underwent NCHT followed by RARP (high-risk group). This study enrolled 227 patients (126: non-high-risk and 101: high-risk group). Patients in the high-risk-group had high-grade cancer compared to those in the non-high-risk-group. Results: At the median follow-up period of 12.0 months, there were no PCa deaths; two patients (0.9%) died of other causes. Twenty patients developed biochemical recurrence (BCR); the median time until BCR was 9.9 months after surgery. The 2-year biochemical recurrence-free survival rates were 94.2% and 91.1% in the non-high-risk and high-risk-group, respectively (p = 0.465). Grade ≥3 NCHT-related adverse events developed in nine patients (8.9%). Conclusions: This study indicates that combining neoadjuvant LHRH antagonists and UFT followed by RARP may improve oncological outcomes in patients with high-risk PCa.

Treatment Strategies for High-Risk Prostate Cancer - Utility of Combination Therapy of Neoadjuvant Therapy and Radical Prostatectomy to Improve Oncologic Outcomes

“…However, gynecomastia, an adverse event caused by the estrogenic effects of EMP, occurs in almost all patients, and there is also a risk of developing deep vein thrombosis. Therefore, we currently perform NCHT with GnRH and tegafur-uracil (UFT) for highrisk PCa [55]. Multiple studies have reported the efficacy and safety of UFT-containing regimens for a variety of malignant neoplasms, including lung cancer, breast cancer, gastric cancer, and castrationresistant PCa (CRPC) [56][57][58][59].…”

“…If PSMA-PET/CT enables pre-treatment diagnosis of micrometastases that cannot be diagnosed by conventional CT or bone scintigraphy, physicians may be able to efficiently select patients with locally advanced PCa who are truly free of metastases, those with a small number of metastases, and those whose prognosis can be extended with pharmaceutical therapy or surgery. Clinical trials are expected to be conducted to determine whether neoadjuvant therapy for these good candidates, such as ARSI or cytotoxic agents, can be more oncologically effective than conventional ADT and improve the oncological outcomes in patients with locally advanced or high-risk PCa [44][45][46][47][48][53][54][55].…”