Research

M Perera, B Beech, M De Jesus Escano, C Gmelich, W Yip, S Boorjian, J Eastham
Neoadjuvant systemic therapy prior to radical prostatectomy for clinical localised high-risk prostate cancer
Frontiers in Urology. 2022, In Press

This study examines the use of radical prostatectomy (RP) as a standard treatment for clinically localized high-risk prostate cancer and explores the role of neoadjuvant therapy (systemic treatment before surgery) in improving outcomes.

Key Points:

  • RP provides excellent local control but patients with high-risk disease are still at significant risk of recurrence due to possible distant or micrometastatic disease at the time of surgery.
  • Neoadjuvant therapy, which includes chemotherapy, hormonal deprivation, and immunologic agents, has been investigated to address these risks.
  • Randomized trials with androgen deprivation therapy showed improved pathologic outcomes, such as downstaging of the disease and reduced risk of positive surgical margins, extracapsular extension, and seminal vesicle invasion.
  • Despite these pathologic improvements, early trials did not consistently demonstrate improved oncologic outcomes post-prostatectomy.
  • More recent trials are exploring novel combinations of chemo-hormonal and immunologic therapies. These studies are still ongoing and may influence future treatment practices.

Conclusion:

The study reviews the pathophysiologic basis and current evidence for neoadjuvant therapy prior to RP in patients with clinically localized high-risk prostate cancer, highlighting the potential for improved treatment strategies pending the outcomes of ongoing trials.

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Dr. Marlon Perera

Dr. Marlon Perera

Dr. Marlon Perera is an Australian-trained, award-winning urology surgeon who specialises in robotic surgery and uro-oncology. Dr. Perera has worldwide experience, having completed a PhD (Urology) and a prized-accredited ‘Society of Urologic Oncology’ (SUO) fellowship at one of the world’s best and most prestigious cancer centres – Memorial Sloan Kettering Cancer Center in New York City. He provides comprehensive care in the treatment of prostate cancer, kidney masses and cancers, bladder cancer, kidney stones, and voiding dysfunction.

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