Abstract 363P
Background
Radical prostatectomy (RP) and radiotherapy (RT) are effective treatments for localized prostate cancer (PCa). The risk of biochemical recurrence and metastasis in PCa patients who received localized therapy remains high. Several clinical trials have explored the efficacy of neoadjuvant hormone therapy (NHT) in PCa, but there is still no consensus on tumor survival benefits.
Methods
PubMed, Embase, Web of Science, and Cochrane Library (CENTRAL) databases have been searched to determine the eligible clinical trials.
Results
A total of 81 clinical trials were included. NHT before RP did not increase the operation time (p=0.833), estimated bleeding loss (p=0.784), and length of hospital stay (p=0.330). The postoperative positive surgical margin rate was significantly decreased in patients who accepted NHT before RP compared with patients who accepted RP only (RR: 0.48, 95% CI: 0.44-0.53, p<0.001). The lymph node invasion rate was also significantly decreased (RR: 0.68, 95% CI: 0.56-0.82, p<0.001). A higher proportion of patients receiving NHT experienced pathological downstaging (RR: 2.18, 95% CI: 1.37-3.48, p=0.001) and organ-confined disease (RR: 1.49, 95% CI: 1.21-1.84, p<0.001). NHT before RP did not improve the rate of biochemical recurrence-free survival (p=0.866), overall survival (p=0.485) and metastasis-free survival (p=0.796). However, NHT before RP may improve the local recurrence-free survival rate (RR: 1.09, 95% CI: 1.01-1.18, p=0.040). NHT did not increase adverse events in patients (p=0.992). NHT before RT benefited PCa patients’ biochemical recurrence-free survival (HR: 0.61, 95% CI: 0.56-0.68, p<0.001), overall survival (HR: 0.85, 95% CI: 0.77-0.94, p=0.001), disease-free survival (HR: 0.57, 95% CI: 0.50-0.64, p<0.001), prostate cancer-specific survival (HR: 0.64, 95% CI: 0.53-0.77, p<0.001), local recurrence-free survival (HR: 0.57, 95% CI: 0.39-0.85, p=0.005), and metastasis-free survival (HR: 0.69, 95% CI: 0.58-0.82, p<0.001).
Conclusions
NHT before RP may not increase the surgical difficulty of RP and adverse events. NHT appeared to benefit the pathological endpoints. NHT did not benefit survival endpoints in patients who received RP. Patients who received NHT before RT experienced survival benefits.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.