Neoadjuvant before surgery treatments: State of the art in prostate cancer

Goal. - To study the impact of systemic treatment in neoadjuvant strategy before surgery in prostate cancer. Materials. - 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. Conclusion. - 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. (C) 2014 Elsevier Masson SAS. All rights reserved.