Neoadjuvant hormone therapy for patients with high-risk prostate cancer

Abstract

This study aimed to identify the pathological outcomes and survival benefits of neoadjuvant hormone therapy (NHT) combined with radical prostatectomy (RP) and radiotherapy (RT) administered to patients with high-risk prostate cancer (HRPCa). We searched PubMed, Embase, and the Cochrane Library for studies comparing NHT plus RP or RT with RP or RT alone, administered to patients with HRPCa. We used a random-effects model to compute risk estimates with 95% confidence intervals (CIs) and quantified heterogeneity using the I 2 statistic. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity. We selected 16 studies. NHT before RP significantly decreased lymph node involvement (risk ratio [RR] = 0.69, 95% CI: 0.56–0.87) and increased the rates of pathological downstaging (RR = 2.62, 95% CI: 1.22–5.61) and organ-confinement (RR = 2.24, 95% CI: 1.54–3.25), but did not improve overall survival and biochemical progression-free survival (bPFS). The administration of NHT before RT to patients with HRPCa was associated with significant benefits for cancer-specific survival (hazard ratio [HR] = 0.51, 95% CI: 0.39–0.68), disease-free survival (HR = 0.51, 95% CI: 0.44–0.60), and bPFS (HR = 0.54, 95% CI: 0.46–0.64). Short-term NHT combined with RT administered to patients with HRPCa conferred significant improvements. Although the advantage of local control was observed when NHT was administered before RP, there was no significant survival benefit associated with HRPCa. Therefore, short-term NHT combined with RT is recommended for implementation in standard clinical practice but not for patients who undergo RP.

Perspective Chapter: Perioperative Considerations for Patients Undergoing Robotic Radical Prostatectomy

“…Although histopathological improvements have been demonstrated (including downstaging, reduced positive margins and lower incidence of positive lymph nodes), clinical oncological parameters of PSA-relapse free survival and cancer specific survival remained static [10]. These findings, supported by a systematic review and meta-analysis, affirm that the use of neo-adjuvant ADT is not routinely recommended prior to radical prostatectomy [11]. However, with the introduction of novel antiandrogens (daralutomide, enzalutamide), there are clinical trials currently underway, assessing the oncological benefits for men receiving these drugs in the neoadjuvant setting [12].…”