Neoadjuvant therapies in high-risk localized prostate cancer: past, present, and future

Treatment for high-risk localized prostate cancer can be particularly challenging because of an elevated risk of disease recurrence. One of the proposed ways to improve the success of definitive localized treatment (such as radical prostatectomy or radiation therapy) for these patients is the addition of neoadjuvant therapy. Thus, therapeutic strategies that have demonstrated benefit in metastatic prostate cancer settings have been translated to and evaluated in the neoadjuvant setting. The therapies studied include androgen deprivation therapy, ranging from androgen receptor-specific blockade to more comprehensive androgen signaling pathway blockade; chemotherapy, especially taxane-based therapy; immunotherapy; and most recently, prostate-specific membrane antigen radioligand therapy. In this review, we provide an overview of various trials that have explored the pathologic and oncologic results of these therapies in various prostate cancer settings and discuss the emerging role of theranostics in this space.