Multimodal strategies combining local and systemic therapy offer the greatest chance of cure for many with men with high-risk prostate cancer who may harbor occult metastatic disease. However, no systemic therapy combined with radical prostatectomy has proven beneficial. This was in part due to a lack of effective systemic agents; however, there have been several advancements in the metastatic and castrate-resistant prostate cancer that might prove beneficial if given earlier in the natural history of the disease. For example, novel hormonal agents have recently been approved for castration-resistant prostate cancer with some early phase II neoadjuvant showing promise. Additionally, combination therapy with docetaxel-based chemohormonal has demonstrated a profound survival benefit in metastatic hormone-naïve patients and might have a role in eliminating pre-existing ADT-resistant tumor cells in the neoadjuvant setting. The Cancer and Leukemia Group B (CALGB)/Alliance 90203 trial has finished accrual and should answer the question as to whether neoadjuvant docetaxel-based chemohormonal therapy provides an advantage over prostatectomy alone. There are also several promising targeted agents and immunotherapies under investigation in phase I/II trials with the potential to provide benefit in the neoadjuvant setting.
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The study was supported by the Sidney Kimmel Center for Prostate and Urologic Cancers, funds provided by David H. Koch through the Prostate Cancer Foundation, and the National Institutes of Health/National Cancer Institute Cancer Center Support Grant to Memorial Sloan Kettering Cancer Center under award number P30 CA008748.
Conflict of Interest
Eugene J. Pietzak and James A. Eastham each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Prostate Cancer
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Pietzak, E.J., Eastham, J.A. Neoadjuvant Treatment of High-Risk, Clinically Localized Prostate Cancer Prior to Radical Prostatectomy. Curr Urol Rep 17, 37 (2016). https://doi.org/10.1007/s11934-016-0592-4
- Chemohormonal therapy
- Neoadjuvant therapy
- Prostate cancer
- Radical prostatectomy