The Impact of Neoadjuvant Hormone Therapy on Surgical and Oncological Outcomes for Patients With Prostate Cancer Before Radical Prostatectomy: A Systematic Review and Meta-Analysis

Abstract

ObjectiveThis systematic study aimed to assess and compare the comprehensive evidence regarding the impact of neoadjuvant hormone therapy (NHT) on surgical and oncological outcomes of patients with prostate cancer (PCa) before radical prostatectomy (RP).MethodsLiterature searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Using PubMed, Web of Science, Chinese National Knowledge Infrastructure, and Wanfang databases, we identified relevant studies published before July 2020. The pooled effect sizes were calculated in terms of the odds ratios (ORs)/standard mean differences (SMDs) with 95% confidence intervals (CIs) using the fixed or random-effects model.ResultsWe identified 22 clinical trials (6 randomized and 16 cohort) including 20,199 patients with PCa. Our meta-analysis showed no significant differences in body mass index (SMD = 0.10, 95% CI: −0.08–0.29, p = 0.274) and biopsy Gleason score (GS) (OR = 1.33, 95% CI: 0.76–2.35 p = 0.321) between the two groups. However, the NHT group had a higher mean age (SMD = 0.19, 95% CI: 0.07–0.31, p = 0.001), preoperative prostate-specific antigen (OR = 0.47, 95% CI: 0.19–0.75, p = 0.001), and clinic tumor stage (OR = 2.24, 95% CI: 1.53–3.29, p < 0.001). Compared to the RP group, the NHT group had lower positive surgical margins (PSMs) rate (OR = 0.44, 95% CI: 0.29–0.67, p < 0.001) and biochemical recurrence (BCR) rate (OR = 0.47, 95% CI: 0.26–0.83, p = 0.009). Between both groups, there were no significant differences in estimated blood loss (SMD = −0.06, 95% CI: −0.24–0.13, p = 0.556), operation time (SMD = 0.20, 95% CI: −0.12–0.51, p = 0.219), pathological tumor stage (OR = 0.76, 95% CI: 0.54–1.06, p = 0.104), specimen GS (OR = 0.91, 95% CI: 0.49–1.68, p = 0.756), and lymph node involvement (OR = 0.76, 95% CI: 0.40–1.45, p = 0.404).ConclusionsNHT prior to RP appeared to reduce the tumor stage, PSMs rate, and risk of BCR in patients with PCa. According to our data, NHT may be more suitable for older patients with higher tumor stage. Besides, NHT may not increase the surgical difficulty of RP.

Neoadjuvant Chemohormonal Therapy in Prostate Cancer Before Radical Prostatectomy: A Systematic Review and Meta-Analysis

“…( 20 ) found no significant difference in operation time and blood loss between NCHT and RP alone group, namely NCHT did not increase the surgical difficulty. Of note, PSM plays a crucial role in predicting biochemical recurrence ( 29 ) and NCHT could improve the pathological outcomes of high-risk PCa in our study, such as reducing PSM and increasing the rate of pathological downstaging, which was consistent with a latest meta-analysis for NHT ( 30 ).…”

Prognostic Impact of Pelvic Lymph Node Dissection During Radical Prostatectomy on Patients With High-risk Prostate Cancer Treated With Neoadjuvant Chemohormonal Therapy

“…30 In a recent meta-analysis, only regimens of neoadjuvant therapy comprising EMP signi cantly reduced the rate of positive nodes (odds ratio: 0.05-0.11). 10,11,24,29 Similarly, the rate of positive nodes in the present study was only 0.8% (2/283) despite the relatively high estimated risk of lymph node invasion (median, 16%). These results suggest that PLND is not bene cial even for nodal staging in patients with high-risk PC who received neoadjuvant chemohormonal therapy containing EMP.…”

“…[24][25][26][27][28] In a neoadjuvant setting, the rate of positive nodes is 0%-30%, with various regimens of neoadjuvant therapy. 29 Although guidelines do not recommend any neoadjuvant therapies outside clinical trials for patients who have elected to undergo RP, 20,21 neoadjuvant therapy is associated with a decreased rate of pT3, a reduced rate of positive surgical margin, and a lower incidence of lymph node metastases. 30 In a recent meta-analysis, only regimens of neoadjuvant therapy comprising EMP signi cantly reduced the rate of positive nodes (odds ratio: 0.05-0.11).…”

Significance of pelvic lymph node dissection during radical prostatectomy in high-risk prostate cancer patients receiving neoadjuvant chemohormonal therapy

“…Although guidelines do not recommend any neoadjuvant therapies outside clinical trials for patients who have elected to undergo RP 20 , 21 , neoadjuvant therapy is associated with a decreased rate of pT3, a reduced rate of positive surgical margin, and a lower incidence of lymph node metastases 30 . In a recent meta-analysis, only regimens of neoadjuvant therapy comprising EMP significantly reduced the rate of positive nodes (odds ratio 0.05–0.11) 10 , 11 , 24 , 29 . Similarly, the rate of positive nodes in the present study was only 0.8% (2/283) despite the relatively high estimated risk of lymph node invasion (median, 16%).…”

“…Generally, PLND during RP is performed in > 90% of patients with high-risk PC 23 , and the rate of positive nodes is 5–37% in patients without neoadjuvant therapy 24 – 28 . In a neoadjuvant setting, the rate of positive nodes is 0–30%, with various regimens of neoadjuvant therapy 29 . Although guidelines do not recommend any neoadjuvant therapies outside clinical trials for patients who have elected to undergo RP 20 , 21 , neoadjuvant therapy is associated with a decreased rate of pT3, a reduced rate of positive surgical margin, and a lower incidence of lymph node metastases 30 .…”