ArticleBMC urology2025
The comparison of outcomes between neoadjuvant novel and classical hormonal therapy in patients with locally advanced prostate cancer: a retrospective study.
Article in BMC urology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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11 authors.
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Abstract
objectiveThis study aimed to compare the outcomes of neoadjuvant novel hormonal therapy (NHT) versus classical hormonal therapy (CHT) before radical prostatectomy (RP) in patients with locally advanced prostate cancer.
methodsPropensity score matching (2:1) was performed to minimize the effect of confounders at our center. We retrospectively analyzed 99 patients who received neoadjuvant hormonal therapy for 3-6 months from March 2019 to April 2023. The novel hormonal agents included apalutamide, darolutamide, or enzalutamide, whereas the classical hormonal agent was bicalutamide. The primary endpoint was pathological response. Secondary outcomes included prostate specific antigen (PSA) complete response rate, biochemical recurrence-free survival (bRFS), and biochemical response rate.
resultsAfter propensity score matching, 63 patients were matched to the CHT group and 36 patients were matched to the NHT group. All patients received androgen deprivation therapy. Pathological response Group 0 was not observed in either group; 41.3% (26/63) of patients in the CHT group achieved a complete response (Group 1), compared with 52.8% (19/36) in the NHT group. Neoadjuvant NHT showed significant advantages over CHT in reducing prostate volume (p < 0.001), downstaging (p = 0.012), and the PSA complete response rate (p = 0.002). PSA complete response was an independent predictor for complete response (OR 2.8, 95%CI 1.14-6.88, p = 0.025). Neoadjuvant NHT also demonstrated a significant improvement in bRFS compared with CHT, and there was a 70% lower risk of biochemical recurrence in the NHT group (HR 0.3, 95% CI 0.17-0.55, p = 0.0006).
conclusionNeoadjuvant NHT resulted in superior pathological responses and PSA responses compared with neoadjuvant CHT in patients with locally advanced prostate cancer. Lower PSA values prior to RP were associated with complete response. Our findings highlighted a significant benefit of neoadjuvant NHT in improving bRFS. CLINICAL TRIAL NUMBER: Not applicable.
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