Long-term Oncological Outcomes of Neoadjuvant Androgen-deprivation Therapy Prior to Radical Prostatectomy

Prostate cancer (PCa) is the second most frequently diagnosed malignancy among men and the fifth leading cause of cancer death in the world. PC remains a heterogeneous disease with an unpredictable course, ranging from indolent forms that may never progress, to initially high and very-high risk of progression, where the mortality associated with PCa remains significant despite optimal treatment. The objective: to evaluate the impact of neoadjuvant androgen-deprivation therapy (NADT) prior to radical prostatectomy (RP) on biochemical recurrence-free, overall, and cancer-specific survival, considering the duration, type, and intensity of NADT, National Comprehensive Cancer Network (NCCN) risk stratification, and the role of adjuvant or salvage external beam radiation therapy (EBRT). Materials and methods. This study included 175 PCa patients who underwent RP between 2015 and 2021. Among them, 84 received NADT and 91 did not. Patients were stratified by NCCN risk groups and EBRT status. Oncological outcomes included biochemical recurrence-free survival (BCRFS), overall survival (OS), cancer-specific survival (CSS), and EBRT-free survival (EBRTFS). Kaplan–Meier and Cox regression analyses were performed. Results. NADT significantly improved BCRFS (hazard ratio = 0.45; p < 0.001), especially in patients who received maximal androgen blockade for ≥ 3 months. The combination of NADT and EBRT showed the most favorable OS and CSS. Patients without NADT or EBRT had the poorest outcomes. NADT was also associated with significantly longer EBRTFS (39 vs 12 months; p < 0.001). Multivariable analysis identified NCCN risk group and EBRT as independent predictors of survival. Conclusions. NADT prior to RP improves BCRFS and potentially enhances long-term oncological outcomes when combined with EBRT. Treatment duration and intensity are key factors in optimizing patient outcomes, especially in high-risk PCa.