Neoadjuvant therapy preceding prostatectomy for prostate cancer: rationale and current trials

Area of Science:

• Oncology
• Urology
• Pathology

Background:

• Neoadjuvant therapy can improve cancer outcomes and provide predictive pathologic data.
• Neoadjuvant androgen-deprivation therapy (ADT) with or without docetaxel chemotherapy before prostatectomy is feasible for localized prostate cancer.
• Current evidence lacks confirmation of improved long-term outcomes with neoadjuvant ADT for prostate cancer.

Purpose of the Study:

• To review data supporting the exploration of neoadjuvant therapy for localized prostate cancer.
• To highlight ongoing trials investigating neoadjuvant ADT combined with docetaxel chemotherapy.
• To emphasize the need to understand the correlation between pathologic/biologic outcomes and long-term results.

Main Methods:

• Review of existing data on neoadjuvant therapy for prostate cancer.
• Discussion of ongoing randomized trials evaluating neoadjuvant ADT and docetaxel.
• Exploration of the feasibility and potential of neoadjuvant approaches in prostatectomy.

Main Results:

• Neoadjuvant ADT, alone or with docetaxel, is feasible and shows pathologic activity in localized prostate cancer.
• The correlation between pathologic/biologic outcomes and long-term survival in this setting remains undetermined.
• The neoadjuvant approach offers a paradigm for evaluating new therapeutic agents, their mechanisms, and resistance.

Conclusions:

• Neoadjuvant therapy followed by prostatectomy is a feasible model for evaluating novel agents.
• Ongoing trials aim to clarify the impact of neoadjuvant ADT and docetaxel on patient outcomes.
• A multidisciplinary approach is crucial for the success of neoadjuvant therapy models in prostate cancer management.