Neoadjuvant Therapy for Locally Advanced or Oligometastatic Prostate Cancer: a Retrospective Comparative Single-Center Study

The optimal neoadjuvant therapy for locally advanced or oligometastatic prostate cancer (PCa) is unclear. We sought to compare characteristics and short-term surgical outcomes between patients with locally advanced or oligometastatic PCa receiving docetaxel-based neoadjuvant chemohormonal therapy (NCHT) versus neoadjuvant hormonal therapy (NHT). Patients in the Cancer Hospital of the University of Chinese Academy of Sciences diagnosed between 2017 and 2020 with locally advanced or oligometastatic PCa and who received NCHT or NHT followed by radical prostatectomy (RP) were evaluated. Characteristics and surgical outcomes were compared between groups using the t test and Cox proportional hazards regression. There were 34 men enrolled in the study and 10 were treated by NCHT and 24 treated by NHT. The NCHT group had significantly higher initial prostate-specific antigen (PSA) (P = 0.008) and more advanced clinical tumor, node, and metastasis stage (P < 0.05) than the NHT group. After neoadjuvant therapy, the median serum PSA level in the NCHT group and the NHT group was 1.61 ng/ml and 0.12 ng/ml, respectively. Furthermore, 40% of patients in the NCHT group and 33.33% of patients in the NHT group were found pathologically down-staging in surgical specimens. The rate of positive surgical margin in the two groups was 20% and 12.5%, respectively. Furthermore, 40% of patients in the NCHT group and 66.67% of patients in the NHT group achieved an undetectable PSA. Neoadjuvant chemohormonal therapy or neoadjuvant hormonal therapy was safe and effective in reducing PSA. Men treated by neoadjuvant chemohormonal therapy had more advanced disease but almost the same short outcomes compared to those treated by neoadjuvant hormonal therapy. Further follow-up is required for recurrence and survival end points.