Neoadjuvant Chemohormonal Therapy before Radical Prostatectomy for Japanese Patients with High-Risk Localized...

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Radical prostatectomy (RP) is standard for high-risk prostate cancer (PCa), but recurrence rates are high, necessitating improved surgical efficacy.
• Neoadjuvant chemohormonal therapy (NCHT) is being explored as a strategy to enhance outcomes before RP.
• This study focuses on Japanese patients with high-risk localized PCa.

Purpose of the Study:

• To evaluate the feasibility and safety of neoadjuvant chemohormonal therapy (NCHT) prior to radical prostatectomy (RP).
• To assess the impact of NCHT on biochemical progression-free survival (bPFS) in high-risk prostate cancer (PCa).
• To compare outcomes between different risk stratification groups (nVHR vs. VHR) within the high-risk category.

Main Methods:

• Prospective study of 21 high-risk PCa patients treated with docetaxel and luteinizing hormone-releasing hormone agonist.
• Three cycles of docetaxel (70 mg/m²) every four weeks, with dose reductions for grade 3-4 toxicities.
• Median follow-up of 88.6 months, with Kaplan-Meier analysis for bPFS.

Main Results:

• The estimated five-year bPFS rate was 57.1%, with docetaxel dose reductions in 13 patients.
• National Comprehensive Cancer Network (NCCN) criteria for very high-risk (VHR) disease was significantly associated with poorer bPFS (p=0.023).
• Five-year bPFS rates were 76.9% for not very high-risk (nVHR) and 25.0% for VHR groups.

Conclusions:

• NCHT demonstrated safety and feasibility in this cohort of Japanese high-risk PCa patients.
• Current NCHT regimens require enhancement to improve outcomes, especially for VHR patients.
• Further research into more extensive treatment modalities is warranted for optimizing survival in high-risk PCa.