This is an interesting paper reporting on the use of neoadjuvant androgen blockage in patients with high-risk prostate cancer undergoing radical prostatectomy. Previous work in the literature has shown an improvement in the rate of organ-confined disease and decreased positive surgical margins, but no overall change to recurrence rates. The difference with this study is the use of newer agents such as ketonconazole, abiraterone and enzalutamide. The study reports on a subset of surgical patients who were participants in a number of trials and is therefore not designed to answer this specific question. They analysed a heterogenous cohort of 72 patients, the majority of which had ≥Gleason 8, seminal vesicle invasion, pT3 disease and / or lymph node involvement with median follow-up of 3.4 years. Ten patients (14%) demonstrated pathologic T downstaging at time of surgery. Three-year biochemical recurrence-free rate was 70% – favourable factors included residual tumour ≤0.5cm or pathologic T downstaging. This study certainly has its limitations but highlights the need for prospective data in this setting.

Post prostatectomy outcomes of patients with high-risk prostate cancer treated with neoadjuvant androgen blockade.
McKay RR, Montgomery B, Xie W, et al.
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Pravisha Ravindra

University Hospitals Leicester NHS Trust.

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