Association between duration of neoadjuvant hormonal therapy and prostate-specific antigen response and pathological outcomes in high-risk prostate cancer undergoing robot-assisted radical prostatectomy.

Purpose: The optimal duration of neoadjuvant hormonal therapy (NHT) for high-risk prostate cancer remains controversial. In this study, we evaluated the association between NHT duration and prostate-specific antigen (PSA) kinetics as well as pathological outcomes in patients who underwent extraperitoneal robot-assisted radical prostatectomy. Methods: We retrospectively analyzed the data of 72 patients with high-risk prostate cancer who received NHT followed by extraperitoneal robot-assisted radical prostatectomy with pelvic lymph node dissection at a tertiary hospital in 2025. Patients were stratified into the short-term (NHT, ≤3 months; n=41) and long-term (NHT, >3 months; n=31) groups. PSA response, pathological features, and perioperative outcomes were compared between the two groups. Results: The PSA nadir was significantly lower in patients who underwent long-term NHT than in those who underwent short-term NHT (median 0.02 vs. 0.23 ng/mL). The proportions of patients in whom PSA levels of <0.1 ng/mL (67.74% vs. 29.27%) and <0.2 ng/mL (83.87% vs. 41.46%) were achieved were significantly higher in the long-term group. Pathological analyses demonstrated a significantly lower incidence of extraprostatic extension in patients undergoing long-term NHT (38.71% vs. 70.73%). Operative time and intraoperative blood loss were similar between the groups. Conclusion: In patients with high-risk prostate cancer, undergoing NHT for longer than 3 months was associated with greater suppression of PSA and more favorable pathological outcomes. Particularly, we observed a reduced incidence of extraprostatic extension and no increase in perioperative morbidity. Achieving a substantial PSA response during NHT may be useful as an indicator for optimizing the timing of surgical intervention.