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.