Neoadjuvant Abitrexone With or Without Docetaxel Versus RP for Locally Advanced PCa

At the 2024 American Urological Association Annual Meeting, Xuan Wang, MD, and colleagues presented study data that compared the efficacy and safety of neoadjuvant abitrexone with or without docetaxel against radical prostatectomy (RP) for patients with locally advanced prostate cancer (PCa).

The nonrandomized, nonblinded, cohort study prospectively enrolled 63 patients with locally advanced PCa who were willing to undergo RP and could tolerate neoadjuvant therapy and surgery. Of the 63 patients, 30 were placed in a study group and 33 were placed in a control group. The outcomes of both arms were compared.

The study group received 6-month neoadjuvant LHRH-α plus abitrexone with prednisone. Prostate-specific antigen (PSA) levels and magnetic resonance imaging (MRI) scans were rechecked at 3 months. If PSA did not decrease to ≤0.1 ng/ml and the clinical stage under MRI did not decrease to within T2, 3-course docetaxel chemotherapy was administered. After 6 months of neoadjuvant treatment, RP was performed. Patients in the control group underwent RP directly.

The initial PSA levels for the study and control groups were 26.90±21.26 ng/ml and 22.56±20.01 ng/ml, respectively (P=.408). No differences in other preoperative characteristics such as Prostate Imaging–Reporting and Data System score, clinical International Society of Urological Pathology  grade, and clinical T stage were noted between the 2 groups.

Postoperative pathology showed that 4 patients in the study group achieved pathological complete response. The maximum diameter of lesions in the study group was 0.92±0.95 cm, while it was 2.84±0.97 cm in the control group (P<.001). Positive surgical margin rates were 13.3% and 54.5%, respectively (P<.001).

The rates of persistent PSA status, postoperative adjuvant therapy, and continence recovery in the study and control groups were 4.8% and 40.0% (P=.004), 13.6% and 51.9% (P=.005), and 81.8% and 51.5%, respectively (P=.022).

In patients with locally advanced PCa, neoadjuvant abitrexone with or without docetaxel can reduce positive surgical margin rates. Further follow-up is needed to determine rates of biochemical recurrence-free survival and overall survival.