Neoadjuvant Androgen-deprivation Therapy Prior to Radical Prostatectomy: Current Evidence and Future Perspectives

Prostate cancer (PCa) is one of the most commonly diagnosed malignant tumors in men and a major cause of cancer-related mortality. Radical prostatectomy (RP) is the standard treatment for localized PCa and, in some cases, for locally advanced PCa. However, a significant proportion of patients develop biochemical recurrence (BCR) following surgery, particularly in cases of intermediate- and high-risk tumors. Neoadjuvant androgen-deprivation therapy (NADT) prior to RP has been investigated as a means of reducing tumor burden, improving surgical conditions and enhancing oncological efficacy. Early studies showed that NADT reduces prostate volume, the incidence of positive surgical resection margins, and induces histopathological changes. However, randomized trials have not confirmed a consistent improvement in long-term outcomes, particularly BCR-free survival and overall survival. Consequently, current clinical guidelines do not recommend the routine use of NADT prior to surgery outside the context of clinical trials. Advances in understanding the biology of PCa and the emergence of new-generation androgen receptor inhibitors have revived interest in intensified neoadjuvant strategies. Current studies demonstrate a more profound pathomorphological response and a reduction in residual tumor burden with the use of combined hormonal regimens. At the same time, there is growing interest in predictive biomarkers for identifying patients who will derive the greatest benefit from neoadjuvant therapy. This review summarizes current data on NADT prior to RP, its biological rationale, clinical and pathomorphological outcomes, duration of treatment and potential predictive biomarkers. Further research should focus on biomarker-guided patient selection and personalized treatment strategies.

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