Oncological outcome of neoadjuvant low-dose estramustine plus LHRH agonist/antagonist followed by extended radical prostatectomy for Japanese patients with high-risk localized prostate cancer: a prospective single-arm study

Abstract

Background Patients with advanced high-risk prostate cancer (PCa) are prone to have worse pathological diagnoses of positive surgical margins and/or lymph node invasion, resulting in early biochemical recurrence (BCR) despite having undergone radical prostatectomy (RP). Therefore, it is controversial whether patients with high-risk PCa should undergo RP. The purpose of this study was to evaluate the efficacy of neoadjuvant chemohormonal therapy (NAC) followed by “extended” RP. Methods A total of 87 patients with high-risk PCa prospectively underwent extended RP after NAC; most of the patients underwent 6 months of estramustine phosphate (EMP) 140 mg twice daily, along with a luteinizing hormone-releasing hormone agonist/antagonist. We developed our surgical technique to reduce the rate of positive surgical margins. We aimed to approach the muscle layer of the rectum by dissecting the mesorectal fascia and continuing the dissection through the mesorectum until the muscle layer of the rectum was exposed. Results More than 1 year had elapsed after surgery in all 86 patients, with a median follow-up period of 37.7 months. The 3-year BCR-free survival was 74.9%. Multivariate Cox-regression analysis revealed that a positive core ratio of 50% or greater and pathological stage of pT3 or greater were independent predictors for BCR. About 17 of 23 cases received salvage androgen deprivation therapy and concurrent external beam radiotherapy, and showed no progression after the salvage therapies. Conclusions NAC concordant with extended RP is feasible and might provide good cancer control for patients with high-risk PCa.

Ameliorating Fibrosis in Murine and Human Tissues with END55, an Endostatin-Derived Fusion Protein Made in Plants

“…Over 60 therapeutic peptides have been approved for use, with hundreds more in clinical trials [ 59 , 60 ]. Peptides are being developed to treat a variety of human conditions, often for multiple implications, such as for neuroprotection [ 61 , 62 , 63 , 64 , 65 ], mitochondrial diseases [ 66 , 67 ], constipation [ 68 ], cancer [ 69 , 70 , 71 , 72 , 73 ], antimicrobials [ 74 , 75 , 76 , 77 ], and diabetes [ 78 , 79 , 80 ].…”

Pathological significance and prognostic role of LATS2 in prostate cancer

“…The clinical benefits of NHT before RP needs clarification 38 . NHT before RP may lead to good control over cancer in patients with high‐risk PC 39 . New NHT strategies before RP, using new hormonal agents are being developed 40 .…”

“… 38 NHT before RP may lead to good control over cancer in patients with high‐risk PC. 39 New NHT strategies before RP, using new hormonal agents are being developed. 40 Therefore, information about predictive markers for the anticancer effects of NHT before RP is important for assessing the treatment strategies; new predictive markers for the anticancer effects of NHT are reported.…”

Neoadjuvant hormone therapy for patients with high-risk prostate cancer

“…Chemotherapy (docetaxel or estramustine) 10 36 37 38 39 40 41 and novel antiandrogens such as abiraterone 42 serve as neoadjuvants combined with neoadjuvant ADT to manage HRPCa. These agents achieve significant local control and prolong the OS and bPFS of patients with HRPCa who undergo prostatectomy.…”