Efficacy of neoadjuvant novel hormonal therapy combined with radical prostatectomy for high-risk prostate cancer and analysis of biochemical recurrence-free survival.

OBJECTIVE

To investigate the efficacy of neoadjuvant novel hormonal therapy (NHT) combined with radical prostatectomy (RP) in patients with high-risk prostate cancer (HRPCa), and identify independent influencing factors for 3-year biochemical recurrence-free survival (BCRFS).

METHODS

A total of 420 patients with HRPCa treated between 2017 and 2022 were enrolled and retrospectively analyzed. All patients were divided into training (n=294) and validation (n=126) sets at a 7:3 ratio. Each cohort was further subdivided into the combination group and the RP-alone control group. Relevant clinical data were collected, and Cox regression analysis, nomogram construction and receiver operating characteristic (ROC) curve analysis were performed.

RESULTS

Baseline data were well balanced between the sets and the groups (all P>0.05). The combination group presented significantly lower positive surgical margin rate (8.7% vs 31.9%), lymph node metastasis rate (10.7% vs 27.8%) and 3-year biochemical recurrence (BCR) rate (12.0% vs 30.6%, all P<0.001), as well as longer BCRFS (34.81±3.27 months vs 33.14±5.67 months, P=0.002). No significant difference was observed in postoperative complication rate between the two groups (4.0% vs 6.9%, P=0.266). Preoperative prostate-specific antigen ≥28.285 ng/mL, Gleason score ≥8.5, positive surgical margin and lymph node metastasis were independent risk factors for BCR (all P<0.003). The area under the ROC curve of the combined prediction model was 0.881 in the training cohort and 0.876 in the validation cohort.

CONCLUSION

NHT combined with RP can improve clinical outcomes of HRPCa without increasing postoperative complications. The four above-mentioned indicators can effectively predict the 3-year BCR risk of patients.