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JU INSIGHT Neoadjuvant Chemohormonal Therapy vs Hormonal Therapy in Locally Advanced Prostate Cancer
By: Hongyang Qian, MD*, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Chenfei Chi, MD*, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Thibault Tricard, MD*, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, France; Yinjie Zhu, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Liang Dong, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Yanqing Wang, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Jianjun Sha, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Jiayi Wang, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Zehua Ma, MD, PhD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Yan Wang, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Jiazhou Liu, MD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Baijun Dong, MD, PhD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Jiahua Pan, MD, PhD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; Wei Xue, MD, PhD, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China; *Co-first authors. | Posted on: 20 May 2024
Qian H, Chi C, Tricard T, et al. A prospective randomized trial of neoadjuvant chemohormonal therapy vs hormonal therapy in locally advanced prostate cancer treated by radical prostatectomy. J Urol. 2024;211(5):648-655. doi:10.1097/JU.0000000000003876
Study Need and Importance
Docetaxel combined with androgen deprivation therapy has been proved to bring significant benefits in improving overall survival for high-volume metastatic prostate cancer (PCa). Consequently, up-front docetaxel-based therapy before definitive local treatments has been explored for its potential advantages in nonmetastatic settings. The benefits of docetaxel-based neoadjuvant chemohormonal therapy (NCHT) prior to radical prostatectomy remain largely unclear in locally advanced PCa, which highlights the need for further investigation.
What We Found
We conducted a prospective trial recruiting 141 cases diagnosed with locally advanced PCa, which were randomized at a ratio of 1:2 to the neoadjuvant hormonal therapy (NHT) group and NCHT group. Our findings revealed that the NCHT group demonstrated significant benefits in 3-year biochemical recurrence-free survival compared to the NHT group (29% vs 9.5%, P = .002) in the management of locally advanced PCa. However, we observed no significant differences between the 2 groups in pathological downstaging and minimal residual disease rates.
Limitations
The limitations of the study include a relatively small population size and limited follow-up duration.
Interpretation for Patient Care
Our findings indicate that administering docetaxel-based NCHT prior to radical prostatectomy may yield significant benefits in 3-year biochemical recurrence-free survival when compared to the NHT group in cases of locally advanced PCa. Given its potential adverse effects, it is essential to approach the docetaxel-based NCHT with thorough evaluation and monitoring.
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