Effects of neoadjuvant endocrine therapy on surgical prognosis and survival period in patients with high-risk localized prostate cancer.

[OBJECTIVE] To investigate the impact of Neoadjuvant Hormonal Therapy (NHT) on surgical prognosis and survival in patients with high-risk localized prostate cancer.

[METHODS] A retrospective analysis was conducted on 371 high-risk prostate cancer patients who were treated at Baoji Central Hospital and Norinco General Hospital from January 2017 to January 2020. The patients were randomly divided into a training set of 286 cases (134 in the non-NHT group and 151 in the NHT group) and a validation set of 86 cases (42 in the non-NHT group and 44 in the NHT group). All patients underwent radical prostatectomy combined with pelvic lymph node dissection (RP+PLND). The baseline characteristics of the training and validation sets were collected. Surgical efficacy indicators (positive surgical margin rate, operative time, blood loss, etc.), 5-year overall survival (OS), metastasis-free survival (MFS), and biochemical recurrence-free survival (BRFS) were compared between the non-NHT and NHT groups in the training set. Independent risk factors for mortality were identified through univariate and multivariate analyses.

[RESULTS] There were no significant differences in the baseline characteristics between the non-NHT and NHT groups in both the validation and training sets. In the training set, the NHT group demonstrated significantly better outcomes than the non-NHT group in terms of positive surgical margin rate (14.57% vs. 39.55%, P < 0.001), intraoperative blood loss (428.64±45.31 ml vs. 494.98±62.36 ml, P < 0.001), and operative time (143.00 min vs. 148.00 min, P < 0.001). The 5-year OS, MFS, and BRFS rates in the NHT group were 82.12% (124/151), 66.23% (100/151), and 40.02% (71/151), respectively, which were significantly higher than 55.97% (75/134), 44.03% (59/134), and 27.61% (37/134) in the non-NHT group (P < 0.001 for all). Multivariate analysis identified non-NHT treatment (OR = 7.528, P < 0.001), open surgery (OR = 4.581, P < 0.001), high clinical stage, high postoperative Gleason score, and high preoperative Prostate-Specific Antigen (PSA) as independent risk factors for mortality. Robotic-assisted surgery significantly reduced the incidence of long-term complications such as urethral stricture and bladder neck contracture compared with open surgery (P < 0.05 for all).

[CONCLUSION] Preoperative NHT can improve surgical efficacy and long-term survival in patients with high-risk prostate cancer without increasing perioperative risks. Robotic-assisted surgery reduces long-term complications. NHT and preoperative PSA can serve as strong predictive indicators for the Nomogram model, providing references for individualized treatment. Further exploration of the optimal course of NHT and precision stratification guided by molecular markers is needed in the future.