Neoadjuvant therapy and prostate cancer: what a urologist should know.
OBJECTIVE
Prostate cancer is curable only when treated at an early stage, when the tumor is still localized to the prostate gland. However, even in apparent cases of clinically localized disease, unsuspected extracapsular disease may significantly increase the risk of primary treatment failure. This risk is especially high if the patient has one or more of the following risk factors: a serum prostate-specific antigen level >20 ng/ml, a Gleason score >7, locally advanced disease (clinical stage T3/T4), and extensive disease on prostate biopsy.


RESULTS
Various regimens of neoadjuvant hormonal therapy and/or chemotherapy have produced mixed results and generally have not influenced the rate of disease relapse (defined by prostate-specific antigen level) in high-risk patients with localized prostate cancer. In addition, antiangiogenic agents, gene therapy, molecular targeting agents, and other promising new therapies have been investigated in a neoadjuvant setting with limited results.


CONCLUSIONS
Despite considerable advances, high-risk localized prostate cancer remains an extremely refractory disease. In patients with high-risk prostate cancer, single-modality treatment in the form of surgery offers a 5-year biochemical disease-free survival rate of no better than 50%. To further elucidate optimal treatment regimens for these patients we must actively enrol patients in clinical trials.
Namiki
Kazunori
K
Department of Urology, University of Florida, Gainesville, Florida 33601, USA.
Rosser
Charles J
CJ
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000628:therapy*; D012306:Risk; D014572:Urology / Q000193:education*
D018931:Antineoplastic Agents, Hormonal