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Purpose <p>Neoadjuvant radiotherapy (RT) in prostate cancer remains investigational. This prospective pilot study evaluated the feasibility, perioperative safety, and preliminary outcomes of neoadjuvant RT combined with androgen-deprivation therapy (ADT), followed by robot-assisted radical prostatectomy (RP), in high-risk locally advanced disease.</p> Methods <p>Patients with high-risk&#xa0;locally advanced prostate cancer (clinical stage T3a–T3b, Gleason score ≥8, or prostate-specific antigen [PSA] ≥ 20&#xa0;ng/mL) were prospectively enrolled. All patients received neoadjuvant RT (50 Gy in 25 fractions) with 3&#xa0;months of ADT, then robot-assisted RP with pelvic lymph node dissection. A retrospective contemporaneous RP-alone cohort served as controls. Primary outcomes included perioperative safety, pathological response, and postoperative PSA levels. Secondary endpoints included oncological&#xa0;outcomes, functional outcomes, and MRI-derived imaging biomarkers.</p> Results <p>In total, 10 patients received neoadjuvant RT, and 11 patients served as controls. The median PSA at diagnosis was 19.46&#xa0;ng/mL in the neoadjuvant group and 15.52&#xa0;ng/mL in controls. No major complications occurred. Pathological downstaging was observed in 60% of the neoadjuvant group, whereas none occurred in controls (4/11 showed upstaging). At 12&#xa0;months, urinary continence was achieved in four patients. After a median follow-up of 16.4&#xa0;months, five patients developed biochemical recurrence, and one progressed to bone metastasis. Post-treatment changes in apparent diffusion coefficient values and T2-weighted MRI signals were associated with improved pathological outcomes, suggesting potential predictive value.</p> Conclusions <p>Neoadjuvant RT with ADT followed by RP is feasible and well tolerated in high-risk&#xa0;locally advanced prostate cancer. Although pathological downstaging was observed, this pilot study does not support definitive conclusions regarding oncologic benefit, and larger prospective studies are warranted.</p>

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Outcomes of Neoadjuvant Radiotherapy Followed by Robotic Radical Prostatectomy in High-Risk Locally Advanced Prostate Cancer: A Prospective Pilot Study

  • 期刊论文

  • 发表日期：

    2026年7月9日

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  • Chi-Shin Tseng,
  • Chih-Kai Chang,
  • Hsing-Ju Li,
  • Yen-Ting Liu,
  • Shi-Wei Huang,
  • Chao-Yuan Huang,
  • Jason Chia-Hsien Cheng

摘要

Purpose

Neoadjuvant radiotherapy (RT) in prostate cancer remains investigational. This prospective pilot study evaluated the feasibility, perioperative safety, and preliminary outcomes of neoadjuvant RT combined with androgen-deprivation therapy (ADT), followed by robot-assisted radical prostatectomy (RP), in high-risk locally advanced disease.

Methods

Patients with high-risk locally advanced prostate cancer (clinical stage T3a–T3b, Gleason score ≥8, or prostate-specific antigen [PSA] ≥ 20 ng/mL) were prospectively enrolled. All patients received neoadjuvant RT (50 Gy in 25 fractions) with 3 months of ADT, then robot-assisted RP with pelvic lymph node dissection. A retrospective contemporaneous RP-alone cohort served as controls. Primary outcomes included perioperative safety, pathological response, and postoperative PSA levels. Secondary endpoints included oncological outcomes, functional outcomes, and MRI-derived imaging biomarkers.

Results

In total, 10 patients received neoadjuvant RT, and 11 patients served as controls. The median PSA at diagnosis was 19.46 ng/mL in the neoadjuvant group and 15.52 ng/mL in controls. No major complications occurred. Pathological downstaging was observed in 60% of the neoadjuvant group, whereas none occurred in controls (4/11 showed upstaging). At 12 months, urinary continence was achieved in four patients. After a median follow-up of 16.4 months, five patients developed biochemical recurrence, and one progressed to bone metastasis. Post-treatment changes in apparent diffusion coefficient values and T2-weighted MRI signals were associated with improved pathological outcomes, suggesting potential predictive value.

Conclusions

Neoadjuvant RT with ADT followed by RP is feasible and well tolerated in high-risk locally advanced prostate cancer. Although pathological downstaging was observed, this pilot study does not support definitive conclusions regarding oncologic benefit, and larger prospective studies are warranted.