[Prostate cancer]

Area of Science:

• Oncology
• Urology

Context:

• Radical prostatectomy and radiation therapy are standard treatments for localized prostate cancer.
• High-risk patients often experience treatment failure.
• Neoadjuvant therapy is explored to improve outcomes before definitive treatment.

Purpose:

• To review randomized controlled studies on neoadjuvant therapy combined with surgery or radiotherapy for localized/locally advanced prostate cancer.
• To evaluate the efficacy of neoadjuvant hormonal therapy in improving survival and pathological outcomes.

Summary:

• Neoadjuvant hormonal therapy before external beam radiation therapy significantly improves disease-free, disease-specific, and overall survival, reducing local recurrence and metastases.
• Neoadjuvant hormonal therapy before prostatectomy did not improve recurrence-free or overall survival but reduced positive surgical margins and improved pathological variables.
• Longer neoadjuvant hormonal therapy (6-8 months) before prostatectomy may further reduce positive surgical margins and potentially improve outcomes.

Impact:

• Findings suggest neoadjuvant hormonal therapy is beneficial before radiation but not definitively before surgery for survival.
• Further research is needed to optimize neoadjuvant hormonal therapy selection, duration, and scheduling.
• Ongoing trials, including neoadjuvant chemotherapy with docetaxel, are anticipated to provide further insights.