Herbal medicines have gained recognition among physicians and patients due to their lower adverse effects compared to modern medicines. They are extensively used to treat various diseases, including cancer, cardiovascular issues, chronic inflammation, microbial contamination, diabetes, obesity, and hepatic disorders, among others. Unfortunately, the clinical application of herbal medicines is limited by their low solubility and inadequate bioavailability. Utilizing herbal medicines in the form of nanocrystals (herbal medicine nanocrystals) has shown potential in enhancing solubility and bioavailability by reducing the particle size, increasing the specific surface area, and modifying the absorption mechanisms. Multiple studies have demonstrated that these nanocrystals significantly improve drug efficacy by reducing toxicity and increasing bioavailability. This review comprehensively examines therapeutic approaches based on herbal medicine nanocrystals. It covers the preparation principles, key factors influencing nucleation and polymorphism control, applications, and limitations. The review underscores the importance of optimizing delivery systems for successful herbal medicine nanocrystal therapeutics. Furthermore, it discusses the main challenges and opportunities in developing herbal medicine nanocrystals for the purpose of treating conditions such as cancer, inflammatory diseases, cardiovascular disorders, mental and nervous diseases, and antimicrobial infections. In conclusion, we have deliberated regarding the hurdles and forthcoming outlook in the realm of nanotoxicity, in vivo kinetics, herbal ingredients as stabilizers of nanocrystals, and the potential for surmounting drug resistance through the utilization of nanocrystalline formulations in herbal medicine. We anticipate that this review will offer innovative insights into the development of herbal medicine nanocrystals as a promising and novel therapeutic strategy.

Background: Brief overview of high-risk/locally advanced prostate cancer in older adults, current neoadjuvant therapies (NHT, NNHT, NCHT), and the uncertainty regarding their comparative efficacy on pathological outcomes. Objectives: This study aims to compare the efficacy and safety profiles of various neoadjuvant treatments in improving pathological outcomes—including positive surgical margin (PSM) rates, minimal residual disease (MRD), clinical downstaging, and post-treatment prostate-specific antigen (PSA) reduction—in older adults with high-risk or locally advanced prostate cancer. Methods: We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science for relevant randomized controlled trials and prospective comparative studies published from January 2010 to April 20, 2025. The primary pathological outcomes were positive surgical margin (PSM) rate and minimal residual disease (MRD). Secondary outcomes included clinical downstaging and prostate-specific antigen (PSA) response. All network meta-analyses were performed using Bayesian frameworks, with treatment ranking evaluated via the surface under the cumulative ranking curve (SUCRA). Results: The network meta-analysis of 15 studies revealed that, according to surface under the cumulative ranking curve (SUCRA) values, novel neoadjuvant hormonal therapy (NNHT) ranked highest for improving key pathological outcomes—notably surgical margin status and post-treatment prostate-specific antigen (PSA) response. While NNHT achieved the highest pathological response rates, it was associated with the most frequent and severe adverse events, highlighting a critical efficacy-toxicity trade-off in clinical decision-making. Conclusions: Our analysis identifies NNHT as the most effective neoadjuvant approach for optimizing pathological endpoints, despite its association with the highest toxicity burden. This efficacy-safety profile supports its prioritization in subsequent trials designed to evaluate long-term survival and comprehensively assess safety outcomes in this population. Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD420251233339.

Objective: High-risk localized prostate cancer is often associated with a higher risk of disease progression post-surgery. While radical prostatectomy (RP) is a cornerstone treatment, neoadjuvant chemohormonal therapy (CHT) combining docetaxel plus androgen deprivation therapy (ADT) prior to RP has shown promising efficacy in improving survival outcomes. This study aimed to evaluate the economic efficacy of neoadjuvant CHT followed by RP based on the results of CALGB 90203 from the perspective of Chinese healthcare system. Methods: A partitioned survival model with three states: event-free survival (EFS), progressive disease (PD), and death, was constructed. Clinical efficacy data, including overall survival and event-free survival, were obtained from the CALGB 90203 trial. Utility values, costs of drugs, surgery, follow-up, and adverse events were derived from local data and literature. Lifetime costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER) of neoadjuvant therapy vs. surgery alone per QALY gained were calculated, with a 5% annual discount rate applied. Cost-effectiveness was assessed against a willingness-to-pay (WTP) threshold of $41,859 per QALY. One-way and probabilistic sensitivity analyses were conducted to test model robustness. Results: Compared with RP alone, the neoadjuvant CHT strategy provided an additional 1.08 QALYs at an incremental cost of $5,663, resulting in an ICER of $5,238 per QALY. The model was most sensitive to changes in health utility values of EFS and PD state. Probabilistic sensitivity analysis indicated a 96.40% probability that neoadjuvant CHT is cost-effective at the defined threshold. Conclusion: From the Chinese payer's perspective, neoadjuvant CHT prior to radical prostatectomy is a highly cost-effective treatment strategy for patients with high-risk localized prostate cancer even when accounting for the upfront costs and quality-of-life impact associated with treatment-related adverse events.