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.