Recovery of urinary continence after neoadjuvant hormonal therapy plus radical prostatectomy: A multicenter retro-prospective cohort study with propensity score matching

Objective This study aimed to evaluate the impact of neoadjuvant hormonal therapy (NHT) combined with robotic-assisted radical prostatectomy (RARP) on postoperative urinary continence recovery compared to RARP alone in patients with localized prostate cancer. Methods A multicenter retro-prospective cohort study was conducted involving 2453 patients treated between November 2018 and November 2023 at four tertiary hospitals in China. After applying exclusion criteria, 1927 patients who completed 1-year follow-up were included (760 NHT plus RARP and 1167 RARP alone). Propensity score matching (1:1) was performed based on age, prostate volume, body mass index, preoperative prostate-specific antigen level, surgical approach, and pT stage, resulting in 249 matched pairs. Urinary continence was defined as using no pad or one safety pad per day and assessed via standardized questionnaires during follow-up visits. Results The NHT group demonstrated significantly better urinary continence recovery compared to the control group ( p <0.001). Median recovery times were 8 weeks (interquartile range: 3–24 weeks) for the NHT group and 16 weeks (interquartile range: 4–34 weeks) for the control group. Short-term continence rates (range: 2–12 weeks) were significantly higher in the NHT group (42% vs. 25%, p <0.001). Multivariate Cox regression analysis identified NHT (hazard ratio 1.273, 95% confidence interval 1.063–1.525, p =0.009) and age (hazard ratio 0.968, 95% confidence interval 0.955–0.980, p <0.001) as independent predictors of urinary continence recovery. Conclusion Preoperative NHT was associated with significantly improved postoperative urinary continence recovery after RARP, including faster recovery time and higher short-term continence rates. These findings suggest that NHT may provide functional benefits beyond its established oncological effects in prostate cancer treatment.