title: [Neoadjuvant before surgery treatments: state of the art in prostate cancer].
abstract: OBJECTIVE
  To study the impact of systemic treatment in neoadjuvant strategy before surgery in prostate cancer.
  
  
  METHODS
  Literature reviews with data analysis from PubMed search using the keywords "neoadjuvant", "chemotherapy", "hormonal therapy", "prostate surgery", "radical prostatectomy", but also reports from ASCO and ESMO conferences. The articles on neoadjuvant treatment before radiotherapy were excluded.
  
  
  RESULTS
  First studies with former therapy are more than 15-years-old and with questionable methodology: lack of power to have a clear idea of the impact on survival criteria such as overall survival or relapse-free survival. However, the impact of neoadjuvant hormone therapy on the classic risk factors for relapse (positive margins, intraprostatic disease, positive lymph nodes) was demonstrated by these studies and a Cochrane meta-analysis. The association with hormone therapy seems mandatory in comparison to treatment based solely on chemotherapy and/or targeted therapy. Promising data on the use of new drugs and their combinations arise: abiraterone acetate combined with LHRH analogue showed a fast PSA decrease and higher rates of pathologic complete response. Other results are promising with hormonal blockages at various key points.
  
  
  CONCLUSIONS
  Studies with 2nd generation anti-androgene agents or enzyme inhibitors seem to show very promising results. To provide answers about the effectiveness of current neoadjuvant strategy in terms of survival, other studies are needed: randomized phase III or phase II exploring predictive biomarkers. The design of such trials requires a multidisciplinary approach with urologists, oncologists, radiologists and methodologists.
authors: Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France.
authors: V
authors: V
authors: Richard
authors: Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France.
authors: M-J
authors: MJ
authors: Paillard
authors: Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France.
authors: G
authors: G
authors: Mouillet
authors: Service de radiothérapie, CHU de Besançon, 25030 Besançon cedex, France; UMR1098, SFR IBCT, université de Franche-Comté, 25020 Besançon, France.
authors: N
authors: N
authors: Lescut
authors: Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France.
authors: T
authors: T
authors: Maurina
authors: Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France.
authors: G
authors: G
authors: Guichard
authors: Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France.
authors: P
authors: P
authors: Montcuquet
authors: Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France.
authors: L
authors: L
authors: Martin
authors: Service d'urologie, CHU de Besançon, 25030 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France; UMR1098, SFR IBCT, université de Franche-Comté, 25020 Besançon, France.
authors: F
authors: F
authors: Kleinclauss
authors: Service d'oncologie médicale, CHU de Besançon, boulevard Flemming, 25030 Besançon cedex, France; Inserm, UMR1098, 25020 Besançon cedex, France; UMR1098, SFR IBCT, université de Franche-Comté, 25020 Besançon, France. Electronic address: a.thieryvuillemin@mac.com.
authors: A
authors: A
authors: Thiery-Vuillemin
mesh_terms: D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D011300:Preoperative Care; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000601:surgery*
keywords: Cancer de la prostate; Chemotherapy; Chimiothérapie; Hormonal therapy; Hormonothérapie; Neoadjuvant; Néoadjuvant; Prostate cancer; Prostatectomie radicale; Radical prostatectomy; Targeted therapy; Thérapies ciblées