Standard androgen deprivation therapy (ADT) isn’t typically used before prostatectomy because there’s never been any real benefit demonstrated in outcomes. But what about more intensive forms of androgen ablation? In this phase 2 trial, 75 men with unfavorable-intermediate and high risk prostate cancer undergoing planned prostatectomy were randomized 1:2 to receive 6 months of neoadjuvant [1] enzalutamide and leuprolide (EL) or [2] EL + abiraterone and prednisone (ELAP) to determine the rate of pathologic complete response (pCR). The rate of either pCR or minimal residual disease (<5 mm residual tumor) was 16% and 30%, respectively. More intensive androgen ablation did not appear to reduce the rate of positive margin (16%) or residual T3 disease (50-60%). TBL: Intensive neoadjuvant androgen ablation results in a dramatic path response in some men, but it remains unclear if this translates into any clinical benefit. | McKay, J Clin Oncol 2018


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