Reviewing chemotherapy and hormonal therapy before prostate surgery in patients with prostate cancer

The review investigated the effects of neoadjuvant chemo-hormonal therapy (NCHT; chemotherapy and hormonal therapy before surgery) in patients with prostate cancer (PCa). The results showed that compared to patients who received prostate surgery alone, NCHT before prostate surgery improved the oncological outcomes of these patients.  

Many patients with PCa undergo prostate surgery (radical prostatectomy; RP) to remove the cancer along with the entire prostate gland and surrounding tissues. Chemotherapy (CT), hormonal therapy (HT) or both CT and HT (CHT) can be given before RP to reduce the size of the tumor before surgery. CHT given before RP is called neoadjuvant CHT (NHT).

One goal of RP is finding no positive surgical margins (PSM; the presence of cancer cells at the edge of removed tissue which states that tumor cells were not completely removed). Along with survival, an important oncological outcome for PCa treatment is biochemical recurrence-free survival (BRFS). This refers to an important blood marker for PCa, the prostate-specific antigen (PSA). PSA starts to rise when the cancer returns. Whether NCHT and RP improve the oncological outcomes of patients with PCa compared to RP alone is still not determined.

This study reviewed 6 other studies involving a total of 1717 patients with PCa. Patients were divided into two groups. Group 1 included 998 patients who received NCHT plus RP, and group 2 included 719 patients who received RP alone. Follow-up time varied between 12.5 months to 141.6 months. 

There was no difference between the 2 groups in terms of lymph node involvement (LNI). However, NCHT before RP significantly reduced the rate of PSM (by 65%) and the cancer invasion of the seminal vesicles (glands above the prostate that produce the sperm fluid that caries spermatozoa; by 22%). The addition of NCHT led to a 64% higher chance of lowering the grade of PCa (pathological downstaging) after surgery compared to RP alone. 

Patients in group 1 had a 46% higher chance of a longer BRFS compared to those in group 2 and a 33% higher chance of a longer survival overall. 

The analysis showed that patients undergoing NCHT followed by RP have improvements in terms of PSM, SVI, pathological downstaging, BRFS, and OS compared to those undergoing RP alone.

There were differences among the studies analyzed. Further studies with a large sample size and longer follow-up periods are required to validate the conclusions.