Introduction

The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) for high-risk Pca patients treated with neoadjuvant therapy comprising a luteinizing hormone-releasing hormone (LHRH) agonist plus low-dose estramustine (EMP) (LHRH agonist + EMP) prior to radical prostatectomy (RP) (Koie T et al. Int J Clin Oncol 2015). In the present study, we evaluated the efficacy of neoadjuvant therapy comprising a LHRH antagonist plus low-dose EMP (LHRH antagonist + EMP) in patients with high-risk Pca.

Methods

Between September 2005 and March 2016, we identified 406 high-risk Pca patients of whom 136 received neoadjuvant LHRH antagonist + EMP and 270 received LHRH agonist + EMP before RP. We retrospectively evaluated the clinical and pathological covariates between the two groups. The primary endpoint was the rate of pathological ?T2 status, and the secondary endpoint was BRFS.

Results

The rates of pathological ?T2 status were 80.2% and 61.5% in the LHRH antagonist + EMP and LHRH agonist + EMP groups, respectively (P < 0.001). The 2-year BRFS rates were 97.8% and 87.8% in the LHRH antagonist + EMP and LHRH agonist + EMP groups, respectively (P = 0.027). Multivariate analysis revealed that biopsy Gleason score, LHRH antagonist + EMP, and clinical T stage were independent predictors of pathological ?T2 status in surgical specimens.

Conclusions

Our findings suggest that neoadjuvant LHRH antagonist + EMP followed by RP may improve the pathological outcomes and reduce the risk of biochemical recurrence in patients with high-risk Pca. Further prospective studies to confirm these findings are warranted.

Funding

none