Renal & Urology NewsIntensified Neoadjuvant Therapy Improves Outcomes in Very High-Risk Prostate Cancer

Patients receiving neoadjuvant abiraterone + ADT had the highest 3-year biochemical progression-free survival rate.

Intensifying neoadjuvant therapy with the addition of abiraterone or docetaxel to androgen deprivation therapy (ADT) may offer significant benefits in pathologic response for patients with very high-risk prostate cancer. The findings come from a pooled analysis of two phase 2 clinical trials and suggest a potential shift in treatment paradigms.

HCN Medical Memo
These findings offer a compelling case for considering intensified neoadjuvant therapy as part of a multimodal treatment approach. Although adverse events were more frequent in the combination therapy groups, the significant improvement in pathologic response and biochemical progression-free survival rates may outweigh these risks for certain patients.

Key Points:

• Hongqian Guo, MD, and colleagues analyzed data from 137 patients, 132 of whom had very high-risk prostate cancer, including 78.8% with locally advanced disease.
• The rate of complete pathologic response or minimal residual disease was significantly higher in groups receiving abiraterone plus ADT (31%) or docetaxel plus ADT (28%) compared to ADT alone (2%).
• The 3-year biochemical progression-free survival rate was 61.2% for abiraterone plus ADT, 51.1% for docetaxel plus ADT, and 41.9% for ADT alone.
• Adverse events were more frequent in the combination therapy groups, with grade 3 or higher events most common in the docetaxel plus ADT group.

Although non-surgical treatment remains the first-line strategy for men with high-risk prostate cancer, therapeutic advances have provided impetus for researchers to consider surgery as part of multimodal therapy.

Additional Points:

• Pre-operative PSA levels of 0.1 ng/mL or less and Gleason score were also predictive to lesser degrees.
• There is currently no consensus on the optimal treatment for men with high-risk prostate cancer, but these findings suggest that intensified neoadjuvant therapy may be beneficial.

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