Prostate Cancer Coverage from Every Angle

Neoadjuvant Chemohormonal Therapy With Radical Prostatectomy for Localized Prostate Cancer

By: Melissa Steele-Ogus
Posted: Thursday, December 10, 2020

Although radical prostatectomy remains one of the primary treatments of localized high-risk prostate cancer, biochemical progression-free survival remains lower than ideal. A study published in the Journal of Clinical Oncology compared the efficacy of radical prostatectomy versus chemohormonal therapy with androgen-deprivation therapy (ADT) plus docetaxel prior to radical prostatectomy. The trial was conducted by researchers nationwide and led by Michael J. Morris, MD, of Memorial Sloan Kettering Cancer Center, New York. They found no difference between the two treatment groups.

“Although some improvement was seen in secondary endpoints, any potential benefit must be weighed against toxicity,” the investigators commented. “Our data do not support the routine use of neoadjuvant chemohormonal therapy and radical prostatectomy in patients with clinically localized, high-risk prostate cancer at this time.”

Patients with clinically localized, high-risk prostate cancer received either radical prostatectomy alone or neoadjuvant chemohormonal therapy with ADT plus docetaxel followed by radical prostatectomy. The primary study endpoint was 3-year biochemical progression-free survival; secondary endpoints included local recurrence, prostate cancer–specific mortality, overall survival, metastasis-free survival, and both 5-year and overall biochemical progression-free survival.

A total of 788 men participated in the study, and the median follow-up was 6.1 years; 397 patients received surgery alone, whereas 391 were additionally given neoadjuvant chemohormonal therapy. The rate of grade 3 adverse events was 26% during chemotherapy, and the rate of grade 4 adverse events was 19%. There was an improved overall 3-year biochemical progression-free survival (hazard ratio = 0.69), overall survival (hazard ratio = 0.61), and metastasis-free survival (hazard ratio = 0.70) with chemohormonal therapy compared with surgery alone. However, there was no statistically significant difference in 3-year biochemical progression-free survival between the surgery (84%) and surgery-plus-chemohormonal therapy (89%) arms (P = .11).

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