In a patient with very high risk prostate cancer opting for prostatectomy, when, if ever, do you recommend neoadjuvant ADT?

I generally do not offer ADT with or without a potent ARSI prior to RP even in high risk disease. While small single arm studies have shown that a few such men can achieve a pathologic CR and that path CR/MRD is associated with better outcomes after RP, for most patients, this approach has no clear ...

The only patients I consider doing neoadjuvant hormone therapy are for those who strongly select prostatectomy instead of definitive prostate radiation but who also have many high risk features making surgical resection more challenging to achieve optimal resection (e.g., T3/T4). Most of these patie...

The data is controversial regarding neoadjuvant therapy in high risk prostate cancer. Multiple trials with neoadjuvant ADT have shown a lack of survival benefit but remarkable improvement in biochemical relapse free interval. The dilemma is heightened by the early detection of metastases on PSMA PET...

In light of the PROTEUS trial, I may consider neoadjuvant ADT plus apalutimide before prostatectomy. The downstaging is significant and could increase the likelihood of achieving negative surgical margins with modern continence-sparing robotic surgeries such as Retzius-sparing and hood technique pro...