Evaluating the outcomes of using hormone therapy before prostate surgery

This study evaluated the surgical and oncological outcomes of using neoadjuvant hormone therapy (NHT) before radical prostatectomy (RP) for patients with prostate cancer (PCa). The study found that NHT before RP was associated with improved surgical and oncological outcomes for these patients.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery to remove the prostate called radical prostatectomy (RP). Another treatment option is hormone therapy (HT) such as androgen deprivation therapy (ADT). ADT reduces the production of androgens (male sex hormones such as testosterone). Reducing these androgens prevents cancer cell growth. Quite often, ADT is administered to reduce tumor size before other treatments such as radiotherapy or surgery. This is referred to as neoadjuvant hormone therapy (NHT).

Previous studies evaluating the use of NHT before RP have contradictory results. Therefore, whether NHT is effective and improves surgical and oncological outcomes when used before RP for PCa is still unknown.

This study analyzed 22 clinical trials which involved 20,199 patients with PCa. The patients were divided into two groups. 3,416 patients received NHT before RP (group 1). 16,783 patients received RP alone (group 2).

Positive surgical margins (PSMs) indicate that some cancer cells have been left behind at the tumor site following surgery. Group 1 had a 56% lower rate of PSMs compared to group 2.

Biochemical recurrence (BCR) means an increase by 0.2 ng/ml from the lowest value of the prostate-specific antigen (PSA; a protein made by cells of the prostate gland). Group 1 also had a 53% lower BCR risk compared to group 2.

This study concluded that NHT before RP reduced the tumor stage, PSMs rate, and risk of BCR in patients with PCa. The authors suggested that NHT before RP might be more suitable for older patients with higher tumor stages.

Most studies did not randomize patients to one treatment or another. The surgical expertise was very different among studies. This may have influenced results.