Anti-Androgens and Cabazitaxel in Defining Complete Response in Prostatectomy (ACDC Trial)

Inclusion Criteria:

* Willing and able to provide informed consent;
* Histologically confirmed adenocarcinoma of the prostate without neuroendocrine differentiation or small cell features with a minimum of 3 cores positive for tumour;
* Tumour biopsy tissue accessible for downstream evaluation;
* Must be candidates for radical prostatectomy and considered surgically resectable by urologic evaluation;
* High Risk D'Amico score defined as either PSA \> 20, Gleason score ≥ 8 as determined by the local pathologist; or T2c-3 based on DRE, pathologic review +/- imaging;
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 1;
* No evidence of metastatic disease or nodal disease as determined by radionuclide bone scans and computed tomography (CT)/magnetic resonance imaging (MRI); non-pathological lymph nodes must be less than 15 mm in the short (transverse) axis;
* Able to swallow the study drug(s) as prescribed and comply with study requirements;
* Required initial laboratory values:
* Absolute neutrophil count (ANC) ≥ 1500/μL;
* Platelet count ≥ 100,000/μL;
* Hemoglobin ≥ 90 g/L;
* Creatinine ≤ 175 μmol/L;
* Bilirubin ≤ upper limit of institutional normal (ULN);
* AST/ALT ≤ 1.5 × ULN.

Exclusion Criteria:

* Received an investigational agent within 4 weeks prior to screening;
* Stage T4 prostate cancer by clinical examination or radiologic evaluation;
* Hypogonadism or severe androgen deficiency as defined by screening serum testosterone below the normal range for the institution;
* Prior androgen deprivation, chemotherapy, surgery, or radiation for prostate cancer;
* Receiving concurrent androgens, estrogens, or progestational agents, or received any of these agents within the 6 months prior to randomization;
* History of another malignancy within the previous 5 years other than curatively treated nonmelanomatous skin cancer and non-muscle invasive bladder cancer;
* Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, cardiovascular disease, unstable angina pectoris, cardiac arrhythmia that is symptomatic or requires active therapy; deep venous thrombosis within 3 months prior to randomization;
* Previous use, or participation in a clinical trial, of an investigational agent that blocks androgen synthesis (e.g., abiraterone acetate, TAK-700, TAK-683, TAK-448) or targets the androgen receptor (e.g., enzalutamide, BMS 641988);
* Liver injury or disease (e.g., viral hepatitis, liver failure Child-Pugh Class C).