Nezasa Minori, Kawase Makoto, Washino Satoshi, Nishino Takato, Fukushima Hajime, Iwatani Kosuke, Miyagawa Tomoaki, Shimbo Masaki, Yamasaki Takeshi, Ohba Kojiro, Miki Jun, Ishida Kenichiro, Koie Takuya
Department of Urology, Matsunami General Hospital, Gifu, Japan.
Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.
Clin Genitourin Cancer. 2025 Jun;23(3):102346. doi: 10.1016/j.clgc.2025.102346. Epub 2025 Apr 9.
The potential improvement in oncological outcomes of robot-assisted radical prostatectomy (RARP) with neoadjuvant androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) who had high-risk or very-high risk disease (HR/VHR-PCa) remains controversial. This study evaluated the impact of neoadjuvant hormone therapy (NHT) on biochemical recurrence (BCR) following RARP.
A total of 1,203 patients with HR/VHR-PCa who underwent RARP at 6 centers in Japan were included. Patients were categorized into 2 groups: those who underwent RARP alone (RARP-alone group) and those who underwent RARP following NHT (NHT group). The primary endpoint was biochemical recurrence-free survival (BRFS) after RARP.
A total of 976 patients were analyzed, including 140 patients in each group after propensity score matching. At a median follow-up of 47 months, BCR was observed in 40.7% of patients in the RARP-alone group and 31.4% in the NHT group (P = .106). BRFS rates did not significantly differ between the 2 groups (P = .671). The RARP-alone group tended to have slightly longer operative times and more positive surgical margins than the NHT group.
This study suggests that NHT does not improve BRFS in patients with HR/VHR-PCa undergoing RARP. Further research is necessary to develop more effective neoadjuvant regimens for this patient population.
对于患有高危或极高危疾病（HR/VHR-PCa）的前列腺癌（PCa）患者，新辅助雄激素剥夺治疗（ADT）联合机器人辅助根治性前列腺切除术（RARP）在肿瘤学结局方面的潜在改善仍存在争议。本研究评估了新辅助激素治疗（NHT）对RARP术后生化复发（BCR）的影响。
纳入了在日本6个中心接受RARP的1203例HR/VHR-PCa患者。患者分为2组：单纯接受RARP的患者（单纯RARP组）和接受NHT后再进行RARP的患者（NHT组）。主要终点是RARP术后无生化复发生存期（BRFS）。
共分析了976例患者，倾向评分匹配后每组各有140例患者。中位随访47个月时，单纯RARP组40.7%的患者出现BCR，NHT组为31.4%（P = 0.106）。两组的BRFS率无显著差异（P = 0.671）。与NHT组相比，单纯RARP组的手术时间往往略长，手术切缘阳性率更高。
本研究表明，NHT并不能改善接受RARP的HR/VHR-PCa患者的BRFS。有必要进一步研究，为该患者群体制定更有效的新辅助治疗方案。
