Neoadjuvant Therapy in High-Risk Prostate Cancer

Area of Science:

• Oncology
• Urology

Background:

• High-risk prostate cancer (PCa) presents significant challenges, including increased recurrence, metastasis, and mortality.
• Defining high-risk PCa is crucial for guiding treatment strategies.

Purpose of the Study:

• To review definitions of high-risk PCa.
• To examine the rationale and contemporary data for neoadjuvant therapy before radical prostatectomy.
• To summarize current evidence on neoadjuvant treatments for high-risk PCa.

Main Methods:

• Review of randomized trials and contemporary data on neoadjuvant androgen deprivation therapy (ADT).
• Analysis of recent level 1 evidence for neoadjuvant chemohormonal therapy (CHT).
• Inclusion of emerging data on immunologic neoadjuvant therapies.

Main Results:

• Historical neoadjuvant ADT trials showed improved pathological parameters (downstaging, reduced positive margins) but not survival.
• Newer ADT studies in high-risk PCa demonstrate promising pathological and oncological results.
• Recent data indicates neoadjuvant CHT may improve survival in high-risk PCa.

Conclusions:

• Neoadjuvant therapies, particularly CHT, show potential for improving outcomes in high-risk and locally advanced prostate cancer.
• Further research into immunologic neoadjuvant approaches is warranted.
• Neoadjuvant treatments are poised to become valuable additions to the prostate cancer therapeutic arsenal.