Abstract
Background: Radical prostatectomy (RP) is increasingly employed as part of a multimodal strategy for treating locally advanced and/or high-risk prostate cancer (LA-HR CaP), though its oncological adequacy alone is limited due to the risk of micrometastatic disease. While androgen deprivation therapy (ADT) with radiation remains the traditional standard, the optimal integration of ADT with RP is yet to be defined. This study introduces the concept of periadjuvant ADT, which combines neoadjuvant ADT, RP, and adjuvant ADT for a total duration of 18 months.
Methods: A retrospective study was conducted on 127 patients with LA-HR CaP who received neoadjuvant ADT (Degarelix ± Abiraterone/Apalutamide) for 3–6 months, followed by RP and continuation of ADT postoperatively. Treatment regimens were individualized based on patient preference and affordability. Data were collected on clinical, operative, pathological, and follow-up parameters. Kaplan-Meier analysis was used for survival outcomes.
Results: The majority (67.7%) of patients were staged as T3, with nodal involvement in 26%. Neoadjuvant therapy was well tolerated, with no significant intraoperative complications (99.2% complication-free). Positive surgical margins and nodal positivity were seen in 24.4% and 26.8% of patients, respectively. Adjuvant radiation was required in 29.1% of cases. At a median follow-up of 12 months, overall survival was 97.6%, with a cumulative Kaplan-Meier survival rate of 94.6%.
Conclusion: Periadjuvant ADT combining neoadjuvant and adjuvant hormonal therapy with RP is a feasible and safe approach for LA-HR CaP in a resource-limited setting. Early results suggest acceptable surgical morbidity and promising short-term oncological outcomes. Longer follow-up is warranted to evaluate survival benefits and refine treatment duration guidelines.