Abstract:

Objective · To evaluate the safety of neoadjuvant therapy which was constituted by docetaxel based systemic chemotherapy and maximal androgen blockage for patients with locally advanced prostate cancer and to summarize the related adverse events and clinical managements.  Methods · From June 2015 to February 2017, the clinical data of 55 patients undergoing neoadjuvant chemotherapy combined with complete androgen deprivation were retrospectively reviewed. The patients were given docetaxel and prednisone as DP regimen every 3 weeks and LHRH analogues with bicalutamide as maximal androgen deprivation for a total of 4 cycles. All treatment-related adverse events were observed and then recorded.  Results · Two cases with liver function impairment after 2 cycles of treatment were withdrawn from the study. No severe allergic reactions occurred during neoadjuvant therapy. The most common adverse events were hematologic toxicity, while 23.6% of patients had grade III-IV neutropenia, and about 12.7% had anemia. Due to a relatively short course of treatment, the skin or mucous damage, peripheral neurotoxicity and fluid retention were rare. However, hot flash, male breast development as well as erectile dysfunction were very frequently observed due to maximal androgen deprivation. The majority of these adverse events were relieved by symptomatic and supportive treatment.  Conclusion · After strict selection, 4 cycles of neoadjuvant chemotherapy combined with total androgen blockade could be well tolerated by the patients with high-risk locally advanced prostate cancer. Even though the adverse events were controllable, they still need to be closely monitored during treatment in order to reduce the incidence. In addition, the very low testosterone level associated endocrinal metabolic disorders caused by complete androgen deprivation were also of great concern.

Key words: high-risk locally advanced prostate cancer, neoadjuvant chemotherapy, complete androgen deprivation, docetaxel, adverse event