You have accessJournal of UrologyCME1 May 2022PD35-02 WHEN IS NEOADJUVANT ANDROGEN DEPRIVATION THERAPY BENEFICIAL FOR HIGHLY AGGRESSIVE PROSTATE CANCER CANDIDATES TO RADICAL PROSTATECTOMY? IMPLICATIONS FOR MULTI-MODAL TAILORED APPROACHES AND TRIALS DESIGN Francesco Barletta, Giorgio Gandaglia, Simone Scuderi, Giuseppe Ottone Cirulli, Elio Mazzone, Armando Stabile, Andrea Necchi, Laura Marandino, Daniele Raggi, Vito Cucchiara, Daniele Robesti, Emanuele Zaffuto, Luigi Nocera, Donato Cannoletta, Mario De Angelis, Pierre I. Karakiewicz, Francesco Montorsi, and Alberto Briganti Francesco BarlettaFrancesco Barletta More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Giuseppe Ottone CirulliGiuseppe Ottone Cirulli More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Armando StabileArmando Stabile More articles by this author , Andrea NecchiAndrea Necchi More articles by this author , Laura MarandinoLaura Marandino More articles by this author , Daniele RaggiDaniele Raggi More articles by this author , Vito CucchiaraVito Cucchiara More articles by this author , Daniele RobestiDaniele Robesti More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Donato CannolettaDonato Cannoletta More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002593.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A revitalized interest on neoadjuvant androgen deprivation therapy (ADT) in prostate cancer (PCa) has been raised by the introduction of novel androgen receptor targeting agents. Identifying men who might benefit from neoadjuvant hormonal manipulation is key for both tailored approaches and for selecting the proper population to include in trials testing new neo-adjuvant therapies. METHODS: We evaluated 411 patients with biopsy GG5 PCa treated with radical prostatectomy (RP) with an extended pelvic lymph node dissection (PLND) between 1995 and 2021. Neoadjuvant or adjuvant treatments (namely, ADT and/or radiotherapy) were administered according to the treating physician’s preference. Biochemical recurrence (BCR) was defined as two PSA values >0.2 ng/ml. Clinical recurrence (CR) was the onset of metastases at conventional imaging. An interaction test assessed whether the impact of the neoadjuvant ADT varied according to a risk score based on preoperative features and developed in men who received RP alone. The observed vs. predicted CR-free survival was plotted for neoadjuvant ADT vs. no neoadjuvant ADT. RESULTS: Median PSA was 10 ng/ml. Overall, 149 (36%) and 55 (14%) patients had cT3 at DRE and cN1 at conventional imaging. Overall, 95 (23%), 161 (40%), and 219 (53%) men received neoadjuvant, adjuvant ADT and/or radiotherapy. A total of 140 (34%) patients received RP alone. The median number of nodes removed was 21. Overall, 238 (58%), 210 (51%) and 179 (44%) patients had pT3b, pN1 and positive margins. Neoadjuvant ADT was associated with lower risk of PSM (33 vs. 48%, p=0.001). Median follow-up was 61 months and 106 men experienced CR. The 7-year CR-free survival rate was 61%. A cT3 (HR: 2.22; p=0.01) and higher PSA (HR: 1.01; p=0.01) predicted CR at multivariable analyses. The impact of neoadjuvant ADT on CR-free survival varied according to a risk score based on cT3, PSA and cN. Men with a risk of CR higher than 40% at 8-year according to the risk score are those who benefit from upfront ADT. CONCLUSIONS: Neoadjuvant ADT might be highly beneficial in patients with biopsy GG5 PCa with aggressive disease characteristics. This should guide the selection of trial populations in this setting. Source of Funding: © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e627 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Barletta More articles by this author Giorgio Gandaglia More articles by this author Simone Scuderi More articles by this author Giuseppe Ottone Cirulli More articles by this author Elio Mazzone More articles by this author Armando Stabile More articles by this author Andrea Necchi More articles by this author Laura Marandino More articles by this author Daniele Raggi More articles by this author Vito Cucchiara More articles by this author Daniele Robesti More articles by this author Emanuele Zaffuto More articles by this author Luigi Nocera More articles by this author Donato Cannoletta More articles by this author Mario De Angelis More articles by this author Pierre I. Karakiewicz More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF DownloadLoading ...