Yang Zhen, Liu Yang, Shao Yuan, Wu Yudong, Wang Yong, Guo Jianing, Liu Zihao, Huang Hua, Tian Jing, Niu Yuanjie, Wen Simeng
Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China.
BMC Urol. 2025 May 24;25(1):136. doi: 10.1186/s12894-025-01811-w.
This study aimed to compare the outcomes of neoadjuvant novel hormonal therapy (NHT) versus classical hormonal therapy (CHT) before radical prostatectomy (RP) in patients with locally advanced prostate cancer.
Propensity score matching (2:1) was performed to minimize the effect of confounders at our center. We retrospectively analyzed 99 patients who received neoadjuvant hormonal therapy for 3-6 months from March 2019 to April 2023. The novel hormonal agents included apalutamide, darolutamide, or enzalutamide, whereas the classical hormonal agent was bicalutamide. The primary endpoint was pathological response. Secondary outcomes included prostate specific antigen (PSA) complete response rate, biochemical recurrence-free survival (bRFS), and biochemical response rate.
After propensity score matching, 63 patients were matched to the CHT group and 36 patients were matched to the NHT group. All patients received androgen deprivation therapy. Pathological response Group 0 was not observed in either group; 41.3% (26/63) of patients in the CHT group achieved a complete response (Group 1), compared with 52.8% (19/36) in the NHT group. Neoadjuvant NHT showed significant advantages over CHT in reducing prostate volume (p < 0.001), downstaging (p = 0.012), and the PSA complete response rate (p = 0.002). PSA complete response was an independent predictor for complete response (OR 2.8, 95%CI 1.14-6.88, p = 0.025). Neoadjuvant NHT also demonstrated a significant improvement in bRFS compared with CHT, and there was a 70% lower risk of biochemical recurrence in the NHT group (HR 0.3, 95% CI 0.17-0.55, p = 0.0006).
Neoadjuvant NHT resulted in superior pathological responses and PSA responses compared with neoadjuvant CHT in patients with locally advanced prostate cancer. Lower PSA values prior to RP were associated with complete response. Our findings highlighted a significant benefit of neoadjuvant NHT in improving bRFS.
Not applicable.
本研究旨在比较局部晚期前列腺癌患者在根治性前列腺切除术（RP）前接受新辅助新型激素疗法（NHT）与经典激素疗法（CHT）的疗效。
进行倾向评分匹配（2:1）以最小化混杂因素在本中心的影响。我们回顾性分析了2019年3月至2023年4月期间接受3 - 6个月新辅助激素治疗的99例患者。新型激素药物包括阿帕他胺、达罗他胺或恩杂鲁胺，而经典激素药物为比卡鲁胺。主要终点是病理反应。次要结局包括前列腺特异性抗原（PSA）完全缓解率、无生化复发生存期（bRFS）和生化反应率。
倾向评分匹配后，63例患者匹配至CHT组，36例患者匹配至NHT组。所有患者均接受雄激素剥夺治疗。两组均未观察到病理反应0级；CHT组41.3%（26/63）的患者达到完全缓解（1级），而NHT组为52.8%（19/36）。新辅助NHT在减小前列腺体积（p < 0.001）、降期（p = 0.012）和PSA完全缓解率（p = 0.002）方面显示出优于CHT的显著优势。PSA完全缓解是完全缓解的独立预测因素（OR 2.8，95%CI 1.14 - 6.88，p = 0.025）。与CHT相比，新辅助NHT在bRFS方面也有显著改善，NHT组生化复发风险降低70%（HR 0.3，95%CI 0.17 - 0.55，p = 0.0006）。
与局部晚期前列腺癌患者的新辅助CHT相比，新辅助NHT产生了更好的病理反应和PSA反应。RP前较低的PSA值与完全缓解相关。我们的研究结果突出了新辅助NHT在改善bRFS方面的显著益处。
不适用。
