Presurgical NHAs May Improve Outcomes For Patients With High-Risk Prostate Cancer

For patients with high-risk prostate cancer, presurgical treatment with novel hormonal agents (NHAs) may reduce the risk of recurrent and progressive cancer when compared with surgical treatment alone, according to a recent study1.

Close to 20% of patients with localized prostate cancers have characteristics that put them at high risk of cancer recurrence and progression, and about two-thirds of deaths from prostate cancer occur in men with high-risk prostate cancers.

Researchers have previously investigated NHAs as an initial therapy before radical prostatectomy (RP) for those with high-risk prostate cancer. Yet, determining whether neoadjuvant NHA therapy followed by RP improves outcomes when compared with RP alone has remained elusive.

To fill that gap in knowledge, the researchers compared two study groups: men with high-risk prostate cancer treated from 2010 to 2016 who underwent RP without any neoadjuvant therapy (n = 259) vs men who received neoadjuvant therapy with NHAs before surgery (neo-RP group; n = 112). The main outcomes of interest were biochemical recurrence and metastasis-free survival. The researchers adjusted their analysis to minimize differences in characteristics between groups.

At 3 years follow-up, after adjusted analysis, 59% of men receiving NHAs before surgery were free of biochemical recurrence compared with 15% of those undergoing RP without neoadjuvant therapy. Additionally, 96% of men in the neo-RP group were alive without evidence of tumor spread after 3 years, compared with 68% in the RP alone group.

Men in the neo-RP group were also less likely to need further treatment compared with the RP alone group, including adjuvant therapy (7% vs 24%, respectively) and salvage therapy (34% vs 46%). The overall survival rate was not significantly different between groups.

There are limitations of the study, including the researchers not accounting for other potential confounding factors that may have contributed to the differences in results in the two groups. The authors noted the need to confirm the benefits of the neo-RP approach in ongoing randomized trials. Still, the results are noteworthy.

“The results suggest significant benefit with [NHA prior to RP] in unselected patients with high-risk prostate cancer," the authors concluded in a press release.2


—Anthony Calabro



  1. Ravi P, Kwak L, Xie W, et al. Neoadjuvant Novel Hormonal Therapy Followed by Prostatectomy versus Up-Front Prostatectomy for High-Risk Prostate Cancer: A Comparative Analysis. J Urol. 2022;208(4):838-845. doi:10.1097/JU.0000000000002803
  2. New hormone therapies before surgery may improve outcomes in high-risk prostate cancer. News release. Wolters Kluwer; September 12, 2022. Accessed November 9, 2022.