{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T08:08:01Z","timestamp":1776586081932,"version":"3.51.2"},"reference-count":28,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,2,19]],"date-time":"2025-02-19T00:00:00Z","timestamp":1739923200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Prostate"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>High\u2010risk patients with prostate cancer (PC) frequently experience biochemical recurrence (BCR) after surgery. Thus numerous studies have investigated the efficacy of neoadjuvant therapies for high\u2010risk PC patients; however, no protocol has been established. This study aimed to assess the effect of androgen deprivation therapy combined with low\u2010dose estramustine phosphate (EMP) on BCR compared with androgen deprivation therapy (ADT) alone in high\u2010 and very high\u2010risk patients with PC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study targeted patients with PC meeting the National Comprehensive Cancer Network high\u2010risk criteria (cT1\u20104N0M0), with 173 patients in the exposure group who received neoadjuvant chemohormonal therapy (gonadotropin\u2010releasing hormone [GnRH] antagonist combined with low\u2010dose EMP), and 490 patients in the control group treated with and neoadjuvant hormone therapy (NHT) (ADT\u2009\u00b1\u2009first\u2010generation anti\u2010androgens). Data for each group were extracted from a database of patients who underwent robot\u2010assisted laparoscopic prostatectomy at 25 tertiary care centers across Japan between 2011 and 2023. The inverse probability of treatment weighting was used to adjust for baseline differences. The primary outcome was BCR\u2010free survival, with hazard ratios (HRs) calculated using a Cox proportional hazards model between the high\u2010risk and very high\u2010risk groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After adjustment, the standardized mean difference was &lt;\u20090.1. The exposure group had 3 and 5\u2010year BCR\u2010free survival rates of 82.1% and 74.6%, respectively, compared with 70.8% and 64.4% in the control group (HR: 0.55; 95% confidence interval [CI]: 0.35\u20130.88). For high\u2010risk patients, the rates were 87.1% and 84.2% at both 3 and 5 years in the intervention group and 83.5% and 75.0% in the control group (HR: 0.66; 95% CI: 0.30\u20131.47). For very high\u2010risk patients, the 3\u2010year and 5\u2010year rates were 75.3% and 65.7% in the intervention group and 57.3% and 53.6% in the control group (HR: 0.53; 95% CI: 0.30\u20130.92).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In patients with very high\u2010risk PC undergoing robot\u2010assisted laparoscopic prostatectomy, a GnRH antagonist and low\u2010dose EMP yielded better BCR\u2010free survival outcomes than NHT.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pros.24875","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T05:14:07Z","timestamp":1740028447000},"page":"684-692","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Neoadjuvant Chemohormonal Therapy With GnRH Antagonist and Low\u2010Dose Estramustine in Very High\u2010Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy"],"prefix":"10.1002","volume":"85","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2913-7364","authenticated-orcid":false,"given":"Takanari","family":"Kambe","sequence":"first","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masashi","family":"Kubota","sequence":"additional","affiliation":[{"name":"Department of Urology Kyoto University Graduate School of Medicine Kyoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-6033","authenticated-orcid":false,"given":"Toshinari","family":"Yamasaki","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mutsushi","family":"Kawakita","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiori","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuto","family":"Hattori","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital Kobe Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoichiro","family":"Tohi","sequence":"additional","affiliation":[{"name":"Department of Urology Kobe City Medical Center General Hospital Kobe Japan"},{"name":"Department of Urology, Faculty of Medicine Kagawa University Kagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuya","family":"Sekine","sequence":"additional","affiliation":[{"name":"Department of Urology Akita University Graduate School of Medicine Akita 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