Efficacy of Neoadjuvant Chemo-hormonal Therapy in Oligometastatic Hormone-Sensitive Prostate Cancer: A Prospective, 3-Arm, Comparative Propensity Score Match Analysis

Abstract Objective : The study aimed to investigate the efficacy and safety outcomes in hormone-sensitive oligometastatic prostate cancer (OMPC) patients treated with docetaxel-based neoadjuvant chemo-hormonal therapy (NCHT) prior to radical prostatectomy (RP) compared with direct RP and standard androgen deprivation therapy (ADT) alone using propensity score match (PSM) analysis. Methods : A single-center, prospective, 3-arm study was conducted by involving hormone-sensitive OMPC patients. Eligible patients (N = 130) were divided into 3 groups, namely NCHT, RP, and standard treatment (ST) groups, and received their respective treatments. Primary end point include progression-free survival (PFS) and secondary end point was pathological response rate, radiographic progression-free survival (rPFS), and overall survival (OS). Further, propensity scores were calculated and group-wise comparisons NCHT vs RP, ST vs RP, and ST vs NCHT was done. Results : After PSM, in the NCHT group, 2 (11.76%) and 4 (23.52%) patients had complete and partial pathological response, respectively. Univariate and multivariate Cox regression analysis showed that PFS and rPFS were significantly higher in the NCHT group (NCHT vs RP; PFS: HR [95% CI]: 0.11 [0.02, 0.51], P = .004; 0.016 [0.0015, 0.17], P Conclusion : PSM analysis revealed NCHT before RP in OMPC patients has potential therapeutic benefits with acceptable toxicities and lower incidence of postoperative positive surgical margins. Microabstract Oligometastatic prostate cancer (OMPC), which is an intermediate state observed along the spectrum of the natural history of prostate cancer. This study investigates the effectiveness and safety outcomes in hormone-sensitive OMPC patients treated with neoadjuvant chemo-hormonal therapy (NCHT) prior to radical prostatectomy (RP). Results from this single-center, prospective, 3-arm study evidenced that docetaxel-based NCHT prior to RP has potential benefits with acceptable toxicity.