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Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer
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 strateg...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285566/ https://www.ncbi.nlm.nih.gov/pubmed/37363117 http://dx.doi.org/10.7759/cureus.40752 |
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author | Sankaran, Sindhu Govindaswamy, Thirumalai Ganesan Dholakia, Kunal Selvaraj, Nivash Kanan, Deerush Tiwari, Madhav Ragavan, Narasimhan |
author_facet | Sankaran, Sindhu Govindaswamy, Thirumalai Ganesan Dholakia, Kunal Selvaraj, Nivash Kanan, Deerush Tiwari, Madhav Ragavan, Narasimhan |
author_sort | Sankaran, Sindhu |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-10285566 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-102855662023-06-23 Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer Sankaran, Sindhu Govindaswamy, Thirumalai Ganesan Dholakia, Kunal Selvaraj, Nivash Kanan, Deerush Tiwari, Madhav Ragavan, Narasimhan Cureus Urology 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. Cureus 2023-06-21 /pmc/articles/PMC10285566/ /pubmed/37363117 http://dx.doi.org/10.7759/cureus.40752 Text en Copyright © 2023, Sankaran et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Urology Sankaran, Sindhu Govindaswamy, Thirumalai Ganesan Dholakia, Kunal Selvaraj, Nivash Kanan, Deerush Tiwari, Madhav Ragavan, Narasimhan Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer |
title | Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer |
title_full | Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer |
title_fullStr | Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer |
title_full_unstemmed | Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer |
title_short | Efficacy of Degarelix in the Neoadjuvant Setting in Managing Locally Advanced Prostate Cancer |
title_sort | efficacy of degarelix in the neoadjuvant setting in managing locally advanced prostate cancer |
topic | Urology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285566/ https://www.ncbi.nlm.nih.gov/pubmed/37363117 http://dx.doi.org/10.7759/cureus.40752 |
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