Efficacy of Neoadjuvant Hormone Therapy Combined with Radical Prostatectomy in Improving Oncological Outcomes for Patients with cT3 Prostate Cancer: A Systematic Review and Meta-Analysis.

Prostate cancer (PCa), especially at clinical stage T3 (cT3), leads to significant health issues and economic costs, highlighting the urgent need for improved treatment strategies. This systematic review and meta-analysis aimed to evaluate the efficacy of neoadjuvant hormone therapy (NHT) combined with radical prostatectomy (RP) in enhancing oncological outcomes for patients with cT3 PCa. We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science for studies published until May 17, 2025. Randomized controlled trials (RCTs) comparing RP alone versus RP with NHT in cT3 PCa patients were included. Primary outcomes were positive surgical margin (PSM) rates and prostate-specific antigen progression-free survival (PSA-PFS). Pooled risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models, depending on heterogeneity. From 9,800 screened records, 10 RCTs were included in the meta-analysis. NHT combined with RP significantly reduced PSM rates (RR=0.75, 95% CI: 0.60-0.94, P=0.01), with improved results noted in patients who received 6 months or more of NHT (RR=0.75, P=0.01). Subgroup analysis revealed pronounced benefits in Asian populations (RR=0.47, P=0.001), whereas North American cohorts showed non-significant trends (RR=0.87, P=0.18). Subgroup analysis showed significant benefits for Asian populations (RR=0.47, P=0.001), while North American groups exhibited trends that were not statistically significant (RR=0.87, P=0.18). NHT combined with RP demonstrated a modest but significant improvement in PSA-PFS (MD=1.60 months, 95% CI: 0.47-2.73, P=0.006), albeit with moderate heterogeneity (I²=65%). Sensitivity analyses and publication bias assessments (Egger's P=0.599; Begg's P=0.655) supported result robustness. NHT in conjunction with RP significantly improves oncological outcomes, particularly regarding PSM and PSA-PFS. However, the long-term survival benefits are still unclear, indicating the need for further research.