Localized high-risk (HR) prostate cancer (PCa) is a heterogeneous disease whose likelihood of a biochemical recurrence, metastatic progression and cancer-related mortality after initial treatment is higher when compared with patients with low (LR) or intermediate-risk (IR) disease. In the past, neoadjuvant therapy has shown an improvement in postoperative oncological variables but failed to demonstrate any survival advantages. With the promising results from novel treatments in metastatic and non-metastatic castration resistant PCa settings, new evidence has appeared in the literature in the neoadjuvant setting.Background/Objectives: To describe the current evidence for different neoadjuvant treatments before a radical prostatectomy in high-risk prostate cancer.Methods: We performed a comprehensive English literature search for original and review articles through January–August 2024, using Pubmed, Medline and ClinicalTrials.gov databases, as well as a comprehensive review of different international guidelines, searching the following terms: “neoadjuvant ADT prostate cancer”, “neoadjuvant ADT”, “prostate cancer surgery” and “neoadjuvant high-risk prostate cancer”. We included 61 papers for the final review.Results and Discussion: Neoadjuvant therapy is not recommended in daily practice by any international guideline. The National Comprehensive Cancer Network (NCCN) guidelines strongly discourage the use of ADT as a neoadjuvant therapy outside of clinical trials. ADT + ARTAs show promising data in phase-II trials, including favorable pCR, MRD, PSA relapse and salvage therapy rates. Clinical trials on chemotherapy,177Lu-PSMA, genomic-targeted therapies and markers of response leave room for further evidence acquisition due to their encouraging results.Conclusions: Currently, no phase III data supports systemic neoadjuvant therapy before RP. Phase II studies show promising data for ADT with second-generation agents, including favorable pCR, MRD, PSA relapse and salvage therapy rates.
局限性高危前列腺癌是一种异质性疾病，与低危或中危患者相比，其初始治疗后发生生化复发、转移进展及癌症相关死亡的风险更高。过去，新辅助治疗虽能改善术后肿瘤学指标，但未能证实可带来生存获益。随着转移性和非转移性去势抵抗性前列腺癌新型疗法取得令人鼓舞的成果，新辅助治疗领域也出现了新的循证依据。 背景/目的：总结高危前列腺癌根治性前列腺切除术前不同新辅助治疗的现有证据。 方法：通过PubMed、Medline和ClinicalTrials.gov数据库对2024年1月至8月期间的原始文献与综述进行系统性英文文献检索，并全面回顾国际指南。检索关键词包括："新辅助ADT前列腺癌"、"新辅助ADT"、"前列腺癌手术"及"新辅助高危前列腺癌"。最终纳入61篇文献进行综述。 结果与讨论：目前国际指南均未推荐在临床实践中常规应用新辅助治疗。美国国家综合癌症网络指南强烈反对在临床试验外使用ADT作为新辅助治疗方案。II期试验显示ADT联合新型内分泌治疗在病理完全缓解率、微小残留病灶、PSA复发率和挽救治疗率方面呈现积极数据。关于化疗、177Lu-PSMA、基因组靶向治疗及疗效标志物的临床试验虽取得鼓舞性结果，但仍需进一步证据支持。 结论：目前尚无III期研究证据支持根治性前列腺切除术前的系统性新辅助治疗。II期研究表明第二代药物联合ADT在病理完全缓解率、微小残留病灶、PSA复发率和挽救治疗率方面具有良好前景。
Current Status of Neoadjuvant Treatment Before Surgery in High-Risk Localized Prostate Cancer
肿瘤(癌症)患者之家