Neoadjuvant Hormone Therapy Before Radical Prostatectomy: Update on the Memorial Sloan-Kettering Cancer Center Trials

Area of Science:

• Urology
• Oncology
• Clinical Trials

Background:

• Radical prostatectomy is a standard treatment for localized prostate cancer.
• Neoadjuvant hormone therapy (NHT) is sometimes used before surgery.
• The impact of NHT on pathologic outcomes and long-term survival remains under investigation.

Purpose of the Study:

• To evaluate the effect of neoadjuvant hormone therapy (NHT) on pathologic results and relapse-free survival in patients with localized prostate cancer.
• To report follow-up data from Phase II and III clinical trials comparing radical prostatectomy with or without NHT.

Main Methods:

• Phase II trial: 141 patients received radical prostatectomy with or without NHT, comparing NHT group with concurrent controls.
• Phase III trial: 140 patients randomized to radical prostatectomy with or without NHT.
• Outcomes assessed included pathologic results (organ-confined disease, margin status) and prostate-specific antigen (PSA) relapse-free survival.

Main Results:

• Phase II: NHT significantly increased organ-confined margin-negative disease (70% vs. 49%, P=0.0057), but no difference in PSA relapse rates (P=0.92).
• Phase III: NHT showed a trend towards more organ-confined disease (70% vs. 59%, P=0.17) and significantly reduced positive margin rates (19% vs. 37%, P=0.023).
• Phase III: No significant difference in PSA relapse rates observed with NHT (P=0.73).

Conclusions:

• Neoadjuvant hormone therapy (NHT) improves pathologic outcomes, specifically reducing positive surgical margins in localized prostate cancer.
• Despite improved pathologic results, NHT did not significantly impact prostate-specific antigen relapse-free survival in the reported follow-up periods.
• Further long-term follow-up is required to determine if the reduction in positive margins translates to improved disease-free survival.