Functional Outcomes of High-Risk Prostate Cancer Patients Treated With Neoadjuvant Androgen Deprivation Therapy (nADT) Prior to Radical Prostatectomy.

INTRODUCTION The oncological benefit of neoadjuvant androgen deprivation therapy (nADT) in high-risk prostate cancer patients has not been proven. The effect of nADT on long-term functional outcomes, namely urinary continence and potency, after radical prostatectomy (RP) is unknown. PATIENTS AND

Methods

This retrospective study analyzed data from a high-volume center, comparing high-risk prostate cancer patients receiving nADT (n = 316 for urinary continence, n = 299 for potency) with those who did not (NonADT). Univariable and multivariable logistic regression models addressed 1 year continence and potency rates.

Results

Overall, patients receiving nADT harbored less favorable clinical and tumor characteristics, namely higher age, more frequent PSA-values > 20 ng/mL, a higher proportion of positive cores in biopsy, and more frequent Gleason Grade Group 5 in biopsy, resulting in lower rates of nerve-sparing surgery. One year after RP, continence rates were comparable (90% vs. 92%; P = .2) according to nADT use, with nADT showing no independent effect on continence in multivariable analyses (odds ratio [OR] 1.08, 95% confidence interval [CI], 0.69-1.73; P = .7). Conversely, 1 year potency rates were significantly lower in the nADT group (26% vs. 37%; P < .001). However, these differences were not significant after multivariable adjustment for clinical and tumor characteristics as well as nerve-sparing surgery (OR 1.17, 95% CI, 0.84-1.62; P = .3).

Conclusion

nADT does not negatively affect postoperative continence. While associated with lower potency rates, this is likely due to the more advanced tumor characteristics of these patients, leading to less nerve-sparing surgery, rather than a direct effect of the therapy itself.