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Updated: Dec 8, 2025
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
Neoadjuvant Treatment of High-Risk, Clinically Localized Prostate Cancer Prior to Radical Prostatectomy
Eugene J Pietzak1, James A Eastham2
1Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. pietzake@mskcc.org.
Abstract:
Multimodal strategies combining local and systemic therapy offer the greatest chance of cure for many with men with high-risk prostate cancer who may harbor occult metastatic disease. However, no systemic therapy combined with radical prostatectomy has proven beneficial. This was in part due to a lack of effective systemic agents; however, there have been several advancements in the metastatic and castrate-resistant prostate cancer that might prove beneficial if given earlier in the natural history of the disease. For example, novel hormonal agents have recently been approved for castration-resistant prostate cancer with some early phase II neoadjuvant showing promise. Additionally, combination therapy with docetaxel-based chemohormonal has demonstrated a profound survival benefit in metastatic hormone-naïve patients and might have a role in eliminating pre-existing ADT-resistant tumor cells in the neoadjuvant setting. The Cancer and Leukemia Group B (CALGB)/Alliance 90203 trial has finished accrual and should answer the question as to whether neoadjuvant docetaxel-based chemohormonal therapy provides an advantage over prostatectomy alone. There are also several promising targeted agents and immunotherapies under investigation in phase I/II trials with the potential to provide benefit in the neoadjuvant setting.
Insights
For men with high-risk prostate cancer, combining surgery with systemic therapies like docetaxel-based chemohormonal therapy may improve outcomes. Ongoing trials are investigating novel agents for earlier disease stages.
Area of Science:
- Oncology
- Urology
- Medical Oncology
Background:
- High-risk prostate cancer necessitates multimodal treatment strategies, including local and systemic therapies, to address potential occult metastatic disease.
- Radical prostatectomy alone has limitations, and no systemic therapy has definitively improved outcomes when combined with it.
- Advancements in treating metastatic and castrate-resistant prostate cancer offer potential for earlier intervention.
Purpose of the Study:
- To evaluate the efficacy of neoadjuvant docetaxel-based chemohormonal therapy in conjunction with radical prostatectomy for high-risk prostate cancer.
- To explore the potential of novel hormonal agents and other systemic therapies in the neoadjuvant setting.
- To assess the role of early systemic therapy in overcoming potential androgen deprivation therapy (ADT) resistance.
Main Methods:
- The study references the CALGB/Alliance 90203 trial, which has completed accrual to compare neoadjuvant docetaxel-based chemohormonal therapy against prostatectomy alone.
- Investigation of early-phase II trials for novel hormonal agents in the neoadjuvant setting.
- Exploration of ongoing phase I/II trials for targeted agents and immunotherapies in the neoadjuvant context.
Main Results:
- Early phase II trials suggest promise for novel hormonal agents in the neoadjuvant setting for castration-resistant prostate cancer.
- Combination therapy with docetaxel-based chemohormonal treatment has shown significant survival benefits in metastatic hormone-naïve prostate cancer.
- The CALGB/Alliance 90203 trial is expected to provide definitive data on the benefit of neoadjuvant docetaxel-based chemohormonal therapy.
Conclusions:
- Multimodal strategies combining local therapy with effective systemic agents are crucial for improving cure rates in high-risk prostate cancer.
- Neoadjuvant systemic therapies, including docetaxel-based chemohormonal therapy, hold promise for eliminating pre-existing ADT-resistant cells and improving outcomes.
- Future research focusing on targeted agents and immunotherapies in the neoadjuvant setting may offer further advancements.
