ESOU18: Reappraisal of Neoadjuvant Therapy for High and Very High-risk Prostate Cancer - No

Amsterdam, The Netherlands ( Studies have attempted to show a benefit with androgen deprivation therapy (ADT) given in the neoadjuvant setting before radical prostatectomy (RP). The results have shown a significant decrease in the rate of positive surgical margins, but no difference in 5 year disease free survival. 

Researchers have argued that the length of neoadjuvant ADT is critical in demonstrating favorable results. However, pooled data have shown that the PSA nadir is the key driver for disease free recurrence, and not the length of neoadjuvant ADT.

Other studies have attempted to assess the role of other various medications in the setting of neoadjuvant treatment before surgery. These have included Abiraterone together with ADT, Enzalutamide + ADT , and enzalutamide and Dutasteride. These studies  have demonstrated a better intra-prostatic  androgen suppression, but no difference in survival outcomes.

Chemotherapy is known to be effective in PC. It is associated with a survival benefit in androgen sensitive disease. There is a rationale for earlier use, but there has not been significant differences seen in outcomes. There is almost no data when chemotherapy is combined with surgery. Longer follow-up is needed, until we even consider this approach as a standard.

Dr. Motet summarized his talk by stating that to date, there is no clear evidence to support usage of any kind of agent in the neoadjuvant setting before RP. We must await results of additional trials to make any kind of evidence-based decision.

Speaker: Nicolas Mottet, MD, PhD University Hospital St. Etienne, Urology St. Etienne, France

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands