Efficacy of Neoadjuvant Hormonal Therapy for High-Risk Prostate Cancer Undergoing Robot-Assisted Radical...

The potential improvement in oncological outcomes of robot-assisted radical prostatectomy (RARP) with neoadjuvant androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) who had high-risk or very-high risk disease (HR/VHR-PCa) remains controversial. This study evaluated the impact of neoadjuvant hormone therapy (NHT) on biochemical recurrence (BCR) following RARP.

A total of 1,203 patients with HR/VHR-PCa who underwent RARP at 6 centers in Japan were included. Patients were categorized into 2 groups: those who underwent RARP alone (RARP-alone group) and those who underwent RARP following NHT (NHT group). The primary endpoint was biochemical recurrence-free survival (BRFS) after RARP.

A total of 976 patients were analyzed, including 140 patients in each group after propensity score matching. At a median follow-up of 47 months, BCR was observed in 40.7% of patients in the RARP-alone group and 31.4% in the NHT group (P = .106). BRFS rates did not significantly differ between the 2 groups (P = .671). The RARP-alone group tended to have slightly longer operative times and more positive surgical margins than the NHT group.

This study suggests that NHT does not improve BRFS in patients with HR/VHR-PCa undergoing RARP. Further research is necessary to develop more effective neoadjuvant regimens for this patient population.