Effect of Neoadjuvant Chemo-Hormonal Therapy on Reducing Recurrence in Patients With Very High-Risk Prostate Cancer Undergoing Robot-Assisted Radical Prostatectomy.

[OBJECTIVE] In this study, we evaluated the efficacy of neoadjuvant chemo-hormonal therapy before robot-assisted radical prostatectomy in patients with very high-risk prostate cancer.

[METHODS] Patients with very high-risk prostate cancer who underwent robot-assisted radical prostatectomy with extended lymph node dissection at our hospital between January 2017 and September 2024 were included. We retrospectively compared the biochemical progression-free survival rates between patients treated with (n = 22) and without (n = 26) neoadjuvant chemo-hormonal therapy. The neoadjuvant chemo-hormonal therapy group received seven-month hormonal therapy (androgen deprivation therapy plus bicalutamide) with 70 mg/m docetaxel (every three weeks over three cycles). Data were analysed using Easy R, Kaplan-Meier method, log-rank test, and Cox proportional hazards model (significance p < 0.05).

[RESULTS] Patient backgrounds showed significant inter-group differences in age (p = 0.010) and initial prostate-specific antigen levels (p = 0.004), but not in clinical T stage (p = 0.355), clinical N stage (p = 0.081), biopsy Gleason score (p = 0.485), or positive biopsy cores (p = 0.105). Despite the less favorable patient backgrounds in the neoadjuvant chemo-hormonal therapy group, 3-year biochemical progression-free survival rates were significantly higher (70.6% vs. 35.3%; p = 0.039). Using multivariate analysis, neoadjuvant chemo-hormonal therapy significantly reduced biochemical recurrence (hazard ratio, 0.34; 95% confidence interval: 0.14-0.83, p = 0.018).

[CONCLUSION] Neoadjuvant chemo-hormonal therapy before robot-assisted radical prostatectomy resulted in favorable biochemical progression-free survival rates in patients with very high-risk prostate cancer. This result suggests that this therapeutic approach has potential for becoming a new standard of care.