Androgen deprivation therapy in combination with radical prostatectomy

Abstract

Radical prostatectomy (RP) is one of the treatment options for patients with localized prostate cancer (PCa). The biochemical recurrence rates in patients with high-risk PCa who underwent RP alone remain high. To date, the clinical benefit, especially with respect to survival, of neoadjuvant therapies, including androgen deprivation therapy (ADT) or chemotherapy, remains unclear. Several prospective, randomized controlled trials showed higher rates of organ-confined disease, reduced rates of extracapsular extension, and reduced rates of positive surgical margins. Although the patients who received neoadjuvant ADT achieved better local tumor control, there were no differences in overall survival (OS) or biochemical recurrence-free survival (BRFS). Patients with locally advanced or seminal vesicle invasion PCa who underwent adjuvant ADT after RP achieved improved 10-year BRFS, local recurrence-free survival, systemic progression-free survival, and cancer-specific survival. However, there was no significant difference in OS. On the contrary, the BRFS rate was higher in high-risk PCa patients treated with neoadjuvant chemohormonal therapy (CHT) than in those treated with RP alone. Neoadjuvant CHT with subsequent RP might reduce the risk of biochemical recurrence.