Background
Prostate cancer holds a substantial presence in the global
cancer landscape, and a considerable proportion of diagnoses occur at late stages, particularly in India. Management of locally advanced
prostate cancer necessitates a
multimodal treatment strategy. A critical part of this strategy is neoadjuvant
androgen deprivation
therapy, typically administered via
luteinizing hormone-releasing hormone (
LHRH) analogs. This study explores the potential of an alternative approach:
neoadjuvant therapy with
degarelix, an
LHRH antagonist, and its impact on perioperative and postoperative outcomes in patients undergoing radical
prostatectomy for locally advanced or high-risk
prostate cancer. Methodology We conducted a retrospective, non-randomized clinical study at Apollo Hospitals in Chennai, India. Patients diagnosed with locally advanced or high-risk
prostate cancer who underwent radical
prostatectomy were included. Participants were patients treated with neoadjuvant
degarelix and subsequent radical
prostatectomy between March 2020 and June 2022. We excluded patients receiving radical
radiotherapy, those switching from
LHRH agonists to antagonists, and those contraindicated for
androgen deprivation
therapy due to existing comorbidities. For comparison, we selected a group from the institutional database who received conventional treatment (i.e., without
neoadjuvant therapy). Results The study compared two groups, each with 32 patients. The groups had no significant difference in total operative duration and console times. The postoperative pathological assessment showed significantly lower margin positivity rates and notable pathological downstaging in the group receiving neoadjuvant
degarelix compared to the control group. The incidence of node positivity,
prostate-specific antigen levels at three months postoperative, and number of pads used per day at one month did not differ significantly between the two groups. Conclusions Our study suggests that neoadjuvant
degarelix could notably enhance patient outcomes in locally advanced
prostate cancer management. The benefits include improved symptom control, significant reductions in margin positivity rates, and facilitated
surgical procedures. Neoadjuvant
degarelix therapy could potentially enhance the feasibility of the surgical intervention in locally advanced
prostate cancer management, thus suggesting a promising pathway for improved patient care.