Neoadjuvant therapy preceding prostatectomy for prostate cancer: rationale and current trials

Abstract

Neoadjuvant therapy improves outcomes for a number of malignancies and provides intermediate pathologic outcomes, which correlate with long-term outcomes. Neoadjuvant androgen-deprivation therapy, alone or with docetaxel chemotherapy, preceding prostatectomy for localized prostate cancer is feasible and demonstrates pathologic activity, but evidence for improved long-term outcomes is lacking. Data in support of the further exploration of neoadjuvant therapy for localized prostate cancer preceding prostatectomy are reviewed. Ongoing randomized trials are elucidating the impact of neoadjuvant androgen deprivation combined with docetaxel chemotherapy on pathologic and long-term outcomes. The correlation of pathologic and biologic outcomes with long-term outcomes in this setting is unknown. The neoadjuvant therapy approach followed by prostatectomy is feasible with a wide array of agents and provides a paradigm for evaluating the activity, and mechanism of action and resistance to new treatments. This promising modality may aid the rapid development of novel therapeutic agents. A multidisciplinary approach involving oncologists, urologists and pathologists is critical to the success of this model.

Keywords::

• androgen-deprivation therapy
• biologic agents
• chemotherapy
• neoadjuvant therapy
• prostate cancer

Financial & competing interests disclosure

Guru Sonpavde is a member of the speakers’ bureau for Sanofi-Aventis, Wyeth, Pfizer and Novartis. He has received research support from BMS, Pfizer, Novartis, Astrazeneca and Cytogen. Guru Sonpavde is also on the advisory board for Celgene, Pfizer, Halozyme, Novartis and BMS. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.