Neoadjuvant hormone therapy plus robot-assisted radical prostatectomy improves pathologic outcomes in high-risk prostate cancer: a retrospective cohort study

To assess the impact of neoadjuvant hormone therapy (NHT) prior to robot-assisted radical prostatectomy (RP) in high-risk prostate cancer (HRPCa). We retrospectively analyzed 141 HRPCa patients who underwent robot-assisted RP from February 2022 to June 2025. According to whether NHT was administered preoperatively, patients were divided into NHT + RP group (n = 27) and RP-alone group (n = 114). The perioperative parameters and pathological outcomes were compared between groups. At the baseline, the NHT + RP group had significantly higher fibrinogen (p = 0.003), AST (p = 0.034), PSA (p = 0.001), and PSA density (p < 0.001), indicating more aggressive disease. Even so, NHT + RP was associated with a trend toward reduced prostate volume (37.70 ± 31.14 vs. 46.07 ± 29.50 ml, p = 0.315) and improved pathological outcomes, including higher rates of pCR (18.5% vs. 0%, p < 0.001) and MRD (7.4% vs. 0%, p = 0.003), as well as a lower PSM rate (33.3% vs. 57.0%, p = 0.027). In multivariable analysis, NHT remained independently associated with reduced PSM (OR = 0.236, 95% CI: 0.068–0.820, p = 0.023). Preoperative NHT followed by robot-assisted RP in HRPCa improved key pathological outcomes, including higher pCR/MRD and lower PSM rates. Given the inherent limitations of the retrospective design, prospective studies are required to validate these findings and their long-term clinical benefit.