Neoadjuvant treatment with androgen receptor signaling inhibitors prior to radical prostatectomy: a systematic review

TY - JOUR

T1 - Neoadjuvant treatment with androgen receptor signaling inhibitors prior to radical prostatectomy: a systematic review

AU - Devos, Gaëtan

AU - Vansevenant, Bram

AU - De Meerleer, Gert

AU - Clinckaert, Andries

AU - Devlies, Wout

AU - Claessens, Frank

AU - Graefen, Markus

AU - Steuber, Thomas

AU - Briganti, Alberto

AU - de la Taille, Alexandre

AU - Van Poppel, Hendrik

AU - Joniau, Steven

N1 - © 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.

PY - 2021/9

Y1 - 2021/9

N2 - CONTEXT: There is an urgent need to develop novel treatment strategies in patients with unfavorable intermediate- and high-risk localized prostate cancer (PCa) to optimize the outcome of these patients. Androgen receptor signaling inhibitors (ARSI) have demonstrated a survival benefit in metastatic hormonesensitive and castration-resistant PCa. A similar benefit might be expected in the localized setting.OBJECTIVE: To perform a systematic review about the role of neoadjuvant ARSI in unfavorable intermediate and high-risk localized PCa.EVIDENCE ACQUISITION: We performed a systematic review of the following databases: MEDLINE (PubMed), EMBASE, Cochrane Library and Web of Science. Publications of ASCO were consulted to identify meeting abstract with early results of ongoing trials. This systematic review was performed and reported in accordance with the PRISMA guidelines.EVIDENCE SYNTHESIS: Pathological complete response (pCR) following neoadjuvant ARSI treatment was observed in 4%-13% of the patients. Minimal residual disease response ranged from 36% to 73.9% when defined as residual cancer burden < 0.25 cm3 at final pathology and from 8% to 20% when defined as the diameter of the remaining tumor < 5 mm. Despite intense neoadjuvant ARSI treatment, residual pT3 disease was observed in 48%-76% of the patients. In contrast, positive surgical margins (PSM) were present in only 5%-22%. Only one trial reported BCR following neoadjuvant ARSI therapy (44% BCR at a median follow-up of 4 years).CONCLUSION: Despite intense neoadjuvant ARSI therapy, pCR is rarely attained and high proportions of pT3 disease are still observed at final pathology. In contrast, promising results are obtained in terms of PSMs. Long-term survival outcomes are eagerly awaited.

AB - CONTEXT: There is an urgent need to develop novel treatment strategies in patients with unfavorable intermediate- and high-risk localized prostate cancer (PCa) to optimize the outcome of these patients. Androgen receptor signaling inhibitors (ARSI) have demonstrated a survival benefit in metastatic hormonesensitive and castration-resistant PCa. A similar benefit might be expected in the localized setting.OBJECTIVE: To perform a systematic review about the role of neoadjuvant ARSI in unfavorable intermediate and high-risk localized PCa.EVIDENCE ACQUISITION: We performed a systematic review of the following databases: MEDLINE (PubMed), EMBASE, Cochrane Library and Web of Science. Publications of ASCO were consulted to identify meeting abstract with early results of ongoing trials. This systematic review was performed and reported in accordance with the PRISMA guidelines.EVIDENCE SYNTHESIS: Pathological complete response (pCR) following neoadjuvant ARSI treatment was observed in 4%-13% of the patients. Minimal residual disease response ranged from 36% to 73.9% when defined as residual cancer burden < 0.25 cm3 at final pathology and from 8% to 20% when defined as the diameter of the remaining tumor < 5 mm. Despite intense neoadjuvant ARSI treatment, residual pT3 disease was observed in 48%-76% of the patients. In contrast, positive surgical margins (PSM) were present in only 5%-22%. Only one trial reported BCR following neoadjuvant ARSI therapy (44% BCR at a median follow-up of 4 years).CONCLUSION: Despite intense neoadjuvant ARSI therapy, pCR is rarely attained and high proportions of pT3 disease are still observed at final pathology. In contrast, promising results are obtained in terms of PSMs. Long-term survival outcomes are eagerly awaited.

KW - Androgen Receptor Antagonists/therapeutic use

KW - Humans

KW - Male

KW - Neoadjuvant Therapy

KW - Preoperative Period

KW - Prostatectomy/methods

KW - Prostatic Neoplasms/drug therapy

KW - Risk Assessment

U2 - 10.1007/s00345-021-03611-x

DO - 10.1007/s00345-021-03611-x

M3 - SCORING: Review article

C2 - 33580296

VL - 39

SP - 3177

EP - 3185

JO - WORLD J UROL

JF - WORLD J UROL

SN - 0724-4983

IS - 9

ER -