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

ABSTRACT 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 2 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.