Neoadjuvant therapies for surgical management of high risk, localized prostate cancer

Surgical management of clinically localized, high-risk prostate cancer is considered a standard of care, however there are known high rates of recurrence and need for adjuvant or salvage therapies. Neoadjuvant systemic therapies (hormonal, chemotherapeutic, immunotherapeutic, other) have been studied with the goal of improving surgical outcomes for these patients. Contemporary evidence does not yet support use of these therapies outside of clinical trials. Neoadjuvant hormonal therapy (NHT) has been shown to improve histopathological outcomes but not more rigorous clinical endpoints. Neoadjuvant docetaxel + hormone therapy has shown promise in phase II studies while phase III evidence is pending. There is ongoing research in the use of novel hormonal and immunotherapeutic agents in the neoadjuvant setting. Future research will determine which agents, alone or in combination, will provide benefit for patients, or subsets of patients, undergoing surgery for high-risk disease.