Gómez Rivas Juan, Ortega Polledo Luis Enrique, De La Parra Sánchez Irene, Gutiérrez Hidalgo Beatriz, Martín Monterrubio Javier, Marugán Álvarez María Jesús, Somani Bhaskar K, Enikeev Dmitry, Puente Vázquez Javier, Sanmamed Salgado Noelia, Galante Romo María Isabel, Moreno Sierra Jesús
Urology Department, Hospital Clínico San Carlos, 28040 Madrid, Spain.
Health Research Institute, Hospital Clínico San Carlos, 28040 Madrid, Spain.
Cancers (Basel). 2024 Dec 31;17(1):99. doi: 10.3390/cancers17010099.
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. : To describe the current evidence for different neoadjuvant treatments before a radical prostatectomy in high-risk prostate cancer. : 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. : 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, Lu-PSMA, genomic-targeted therapies and markers of response leave room for further evidence acquisition due to their encouraging results. : 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（HR）前列腺癌（PCa）是一种异质性疾病，与低危（LR）或中危（IR）疾病患者相比，其初始治疗后生化复发、转移进展和癌症相关死亡率的可能性更高。过去，新辅助治疗虽在术后肿瘤学变量方面有所改善，但未能显示出任何生存优势。随着转移性和非转移性去势抵抗性PCa新型治疗取得的令人鼓舞的结果，新辅助治疗领域在文献中也出现了新证据。：描述高危前列腺癌根治性前列腺切除术之前不同新辅助治疗的当前证据。：我们通过使用PubMed、Medline和ClinicalTrials.gov数据库，对2024年1月至8月期间的原始文章和综述文章进行了全面的英文文献检索，并对不同的国际指南进行了全面回顾，检索了以下术语：“新辅助雄激素剥夺治疗前列腺癌”、“新辅助雄激素剥夺治疗”、“前列腺癌手术”和“新辅助高危前列腺癌”。我们纳入了61篇论文进行最终综述。：任何国际指南在日常实践中均不推荐新辅助治疗。美国国立综合癌症网络（NCCN）指南强烈不鼓励在临床试验之外将雄激素剥夺治疗用作新辅助治疗。雄激素剥夺治疗+雄激素受体靶向拮抗剂（ARTAs）在II期试验中显示出有前景的数据，包括良好的病理完全缓解（pCR）、微小残留病（MRD）、前列腺特异性抗原（PSA）复发率和挽救治疗率。由于化疗、镥-前列腺特异性膜抗原（Lu-PSMA）、基因组靶向治疗和反应标志物的临床试验结果令人鼓舞，因此仍有进一步获取证据的空间。：目前，尚无III期数据支持在根治性前列腺切除术（RP）前进行全身新辅助治疗。II期研究显示第二代药物进行雄激素剥夺治疗有前景的数据，包括良好的pCR、MRD、PSA复发率和挽救治疗率。
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