Neoadjuvant androgen deprivation therapy before radical prostatectomy in high-risk and very high-risk prostate cancer

Purpose: Neoadjuvant systemic therapy is a standard of care for several solid tumor malignancies. It has been evaluated before radical prostatectomy (RP) in recent studies but no consensus yet. This study investigates the outcomes of high-risk prostate adenocarcinoma receiving RP with or without neoadjuvant androgen deprivation therapy (ADT). Materials and methods: This study included 175 patients diagnosed with high- or very high-risk prostate adenocarcinoma who underwent robotic-assisted RP with pelvic lymph node dissection from January 2017 to December 2022. Among them, 50 patients received neoadjuvant ADT before the operation. The study analyzed baseline characteristics, comorbidities, and surgical outcomes, comparing approaches using chi-squared and Student t tests. Results: Of the 175 patients, a total of 50 (28.7%) patients received neoadjuvant ADT and 124 (71.3%) did not. On comparing the prostate-specific antigen (PSA) level between the 2 groups, we found that the initial PSA were significantly higher in neoadjuvant ADT group ( P = 0.025) and also significantly dropped to lower level before operation when comparing with non-neoadjuvant ADT group ( P < 0.001). Clinical stage according to magnetic resonance imaging also showed downstaging in neoadjuvant ADT group. Pathological stage showed no difference between the 2 groups ( P = 0.847) but surgical margin-free rate was higher in neoadjuvant ADT group (50% versus 70%, P = 0.016). Disease-free rate ( P = 0.363) and PSA recurrence rate ( P = 0.774) showed no difference between the 2 groups. Upon neoadjuvant ADT group, primary biopsy Gleason score and residual tumor volume can be predicators for the disease progression. No cancer-related mortality was noted. Conclusion: This study supports that neoadjuvant ADT group had better surgical outcomes and no lower prognosis compared with non-neoadjuvant ADT group. Neoadjuvant ADT before RP can be considered in high- or very high-risk prostate adenocarcinoma patients.