Neoadjuvant chemohormonal therapy before radical prostatectomy in high-risk prostate cancer: a mini-review.

IF 1.5 Q3 UROLOGY & NEPHROLOGY American journal of clinical and experimental urology Pub Date : 2024-02-15 eCollection Date: 2024-01-01
Junjie Fan, Zhangdong Jiang, Guojing Wang, Dalin He, Kaijie Wu
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Abstract

High-risk localized prostate cancer (PCa) has the potential of recurrence and progression to a lethal phenotype, and neoadjuvant therapy followed by radical prostatectomy (RP) may be an option for these patients. Docetaxel has been recently shown to be an effective chemotherapeutic agent for high-volume metastatic hormone-sensitive PCa and metastatic castration-resistant PCa, and these increased efficacy create the impetus to assess the potential role of preoperative docetaxel in high-risk localized PCa. In this mini-review, we found that neoadjuvant chemohormonal therapy (NCHT) may be an effective neoadjuvant regimen to improve oncological outcome of high-risk PCa. However, the addition of docetaxel in the neoadjuvant setting would unavoidably increase the rate of adverse events, impose additional economic burdens. Therefore, suitable patient selection is crucial and pathological response might be a surrogate endpoint. Furthermore, we also found that molecular imaging prostate-specific membrane antigen (PSMA) PET/CT was a promising tool to evaluation the effectiveness of NCHT, and the expression status of AR, AR-V7, Ki-67, PTEN and TP53 might be helpful for urologists to identify more suitable candidates for NCHT.

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高危前列腺癌根治性前列腺切除术前的新辅助化疗:微型综述。
高危局部前列腺癌(PCa)有可能复发并发展为致命的表型,对这些患者来说,新辅助治疗后进行根治性前列腺切除术(RP)可能是一种选择。多西他赛最近已被证明是治疗高体积转移性激素敏感性PCa和转移性阉割耐药PCa的有效化疗药物,这些疗效的提高推动了对术前多西他赛在高危局部PCa中潜在作用的评估。在这篇微型综述中,我们发现新辅助化疗激素疗法(NCHT)可能是改善高危 PCa 肿瘤治疗效果的有效新辅助方案。然而,在新辅助治疗中加入多西他赛将不可避免地增加不良反应的发生率,并带来额外的经济负担。因此,选择合适的患者至关重要,病理反应可能是一个替代终点。此外,我们还发现,分子影像学前列腺特异性膜抗原(PSMA)PET/CT是评估NCHT疗效的有效工具,而AR、AR-V7、Ki-67、PTEN和TP53的表达状态可能有助于泌尿科医生识别更多适合NCHT的患者。
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