Efficacy of neoadjuvant hormonal therapy combined with robot-assisted radical prostatectomy for oligometastatic prostate cancer: a multicenter retrospective study

Objective To evaluate the efficacy of neoadjuvant hormonal therapy (NHT) on perioperative and oncological outcomes in patients with oligometastatic prostate cancer (OmPCa) treated with robot-assisted radical prostatectomy (RARP) and adjuvant androgen-deprivation therapy (ADT). Methods In this multicenter retrospective study, 160 OmPCa patients treated from five Chinese medical centers between May 2010 and May 2023 were included: 80 received NHT followed by RARP+ADT, and 80 underwent RARP+ADT alone. We evaluated surgical information, pathological findings, biochemical progression-free survival (bPFS), radiological progression-free survival (rPFS), overall survival (OS), subsequent treatments, and ADT-related adverse events. Results Compared to the standard therapy (ST) group, the NHT group exhibited shorter operative time (170 vs. 200min; P = 0.030), less blood loss (100 vs. 200 mL; P = 0.022), lower positive surgical margin rate (17.50% vs. 37.50%; P = 0.005), and higher rates of pathological downstaging in T-stage (48.8% vs. 6.3%; P<0.001). More NHT patients achieved undetectable PSA (83.8% vs. 65.0%; P = 0.007) with a shorter time to PSA nadir (2 vs. 3 months; P = 0.002). After a median postoperative follow-up of 52 months, no significant differences were observed in bPFS, rPFS or OS between groups. However, subgroup analysis revealed significant interaction effects between NHT and biopsy Gleason score ≥8, seminal vesicle invasion, and clinical T stage ≥ T3 (all P-interaction<0.05), with these subgroups showing significantly improved bPFS, rPFS and OS. Furthermore, patients in the NHT group received fewer subsequent treatments (32.5% vs. 47.5%, P = 0.031), and the incidence of ADT-related adverse events was comparable between the two groups (all P >0.05). Conclusion NHT improves perioperative outcomes and reduces the need for subsequent salvage therapies in OmPCa patients undergoing RARP. It may offer oncological benefits, particularly those with a biopsy Gleason score ≥8 or clinical T-stage≥T3. It represents a safe and feasible neoadjuvant approach.