Comparison of short-term and long-term neoadjuvant hormone therapy prior to radical prostatectomy: a systematic review and meta-analysis

Abstract

Purpose

This study aimed to evaluate the efficacy of long-term neoadjuvant androgen-deprivation therapy (ADT) before radical prostatectomy (RP).

Methods

We conducted meta-analyses and network meta-analyses, which included randomized controlled trials that assessed patients with prostate cancer (PC) who received either short-term (<6 months) or long-term (≥6 months) neoadjuvant ADT before RP.

Results

Thirteen articles with 2778 patients were eligible for analysis. Short-term neoadjuvant ADT was neither associated with biochemical recurrence (OR 1.19, 95% CI, 0.93–1.51, p = 0.17), metastasis (OR 0.73, 95% CI, 0.45–1.19, p = 0.21), nor overall mortality (OR 0.72, 95% CI 0.43–1.21, p = 0.22); no study investigated survival outcomes in patients on long-term neoadjuvant ADT. In terms of pathologic outcomes, long-term neoadjuvant ADT was significantly associated with a reduced risk of positive surgical margin (SM) and an increased rate of organ-confined disease (OCD) compared to short-term neoadjuvant ADT (OR 0.56, 95% CI 0.39–0.80, p = 0.001, and OR 1.48, 95% CI 1.10–1.99, p = 0.009, respectively). These findings were confirmed in the network meta-analyses. Meanwhile, only a non-significant trend favoring long-term neoadjuvant ADT was observed for pathologic complete response (OR 1.98, 95% Crl 1.00–3.93).

Conclusion

Long-term neoadjuvant ADT was associated with more favorable pathologic outcomes, but whether these findings translate into favorable survival outcomes still remains unproven due to very limited evidence. Since there are no reliable survival data, long-term neoadjuvant ADT before RP should not be used in clinical practice until more robust evidence arises from ongoing trials.

Keywords:

• ADT
• neoadjuvant
• duration
• long-term
• radical prostatectomy
• meta-analysis

Author contributions

S. Katayama: project development, data collection, and manuscript writing. K. Mori: data management. B. Pradere: manuscript editing. H. Mostafaei and V. M. Schuettfort: data management. F. Quhal, R. Sari Motlagh E. Laukhtina, N. C. Grossmann, P. Rajwa, A. Aydh, and F. König: data collection. R. Mathieu, P. Nyirady, P. I. Karakiewicz, and Y. Nasu: manuscript editing. S. F. Shariat: project development and manuscript editing.

Disclosure statement

All authors state that they have no conflict of interest that might bias this work.

Additional information

Funding

Ekaterina Laukhtina is supported by the EUSP Scholarship of the European Association of Urology (EAU). Nico C. Grossmann is supported by the Zurich Cancer League. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.