Nakane Keita, Kawase Makoto, Kato Daiki, Iinuma Koji, Kawase Kota, Takeuchi Shinichi, Tobisawa Yuki, Ito Takayasu, Koie Takuya
Department of Urology, Graduate School of Medicine, Gifu University, Yanagido, Gifu, Japan.
Center for Clinical Training and Career Development, Graduate School of Medicine, Gifu University, Yanagido, Gifu, Japan.
Transl Cancer Res. 2024 Jul 31;13(7):3889-3897. doi: 10.21037/tcr-23-2394. Epub 2024 Jul 8.
Prostate cancer (PCa) is the most common cancer in men. High-risk PCa is associated with an increased risk of PCa-related death. The combined use of androgen deprivation therapy (ADT) is essential to improve oncological outcomes in patients with high-risk PCa, and relatively long-term ADT administration is preferred when radiotherapy is performed. Meanwhile, whether neoadjuvant therapy for radical prostatectomy (RP) improves oncological outcomes remains controversial. This study aimed to review the oncological outcomes of RP in high-risk PCa and emphasize the significance of neoadjuvant therapy including neoadjuvant hormonal therapy (NHT) and neoadjuvant chemohormonal therapy (NCHT) followed by RP for managing high-risk PCa.
We searched for articles published in the PubMed and Scopus databases from January 1, 2005 to March 30, 2023 using the medical subject headings (MeSH) terms: prostate cancer, prostatectomy, radiation therapy, neoadjuvant therapy, and treatment outcome.
The study on NHT before RP for high-risk PCa found that NHT was associated with reduced adverse pathological features, such as pT3, positive surgical margins (PSM), and lymph node involvement. However, despite shorter operative times and improved surgical outcomes, NHT did not significantly enhance biochemical recurrence (BCR) or other oncological outcomes. The combination therapy using ADT and androgen receptor signaling inhibitors (ARSI) showed varying results. Another investigation explored NCHT with taxane-based agents, indicating acceptable treatment benefits and improved BCR-free survival rates in high-risk PCa patients, demonstrating potential feasibility for this approach. Ongoing trials, like the PROTEUS trial, aim to further evaluate the therapeutic efficacy of neoadjuvant therapy in high-risk PCa.
NHT for high-risk PCa does not contribute to improved oncological outcome and should not be administered easily for downstaging or PSM reduction. NHT in combination with ARSI has the potential advantage of improving the oncological outcome of high-risk PCa compared to RP alone, but the results are currently unsatisfactory, and the development of individualized treatment strategies using several different therapeutic approaches is needed.
前列腺癌（PCa）是男性中最常见的癌症。高危PCa与PCa相关死亡风险增加有关。联合使用雄激素剥夺疗法（ADT）对于改善高危PCa患者的肿瘤学结局至关重要，并且在进行放射治疗时，首选相对长期的ADT给药。与此同时，前列腺癌根治术（RP）的新辅助治疗是否能改善肿瘤学结局仍存在争议。本研究旨在回顾高危PCa患者RP的肿瘤学结局，并强调新辅助治疗（包括新辅助激素治疗（NHT）和新辅助化疗激素治疗（NCHT））随后进行RP在管理高危PCa中的重要性。
我们使用医学主题词（MeSH）术语：前列腺癌、前列腺切除术、放射治疗、新辅助治疗和治疗结局，在PubMed和Scopus数据库中检索了2005年1月1日至2023年3月30日发表的文章。
关于高危PCa患者RP前NHT的研究发现，NHT与不良病理特征减少有关，如pT3、手术切缘阳性（PSM）和淋巴结受累。然而，尽管手术时间缩短且手术结局改善，但NHT并未显著提高生化复发（BCR）或其他肿瘤学结局。使用ADT和雄激素受体信号抑制剂（ARSI）的联合治疗显示出不同的结果。另一项研究探索了基于紫杉烷类药物的NCHT，表明在高危PCa患者中治疗益处可接受且无BCR生存率提高，证明了该方法的潜在可行性。正在进行的试验，如PROTEUS试验，旨在进一步评估新辅助治疗在高危PCa中的治疗效果。
高危PCa的NHT无助于改善肿瘤学结局，不应轻易用于降期或减少PSM。与单独的RP相比，NHT联合ARSI有可能改善高危PCa的肿瘤学结局，但目前结果并不理想，需要开发使用几种不同治疗方法的个体化治疗策略。
