Neoadjuvant Leuprolide Therapy with Radical Prostatectomy: Long-term Effects on Health-related Quality of Life

Background Neoadjuvant androgen ablation (neoadjuvant androgen deprivation therapy [NADT]) is used prior to radical prostatectomy, contrary to guidelines, but its long-term effects on quality of life is unknown. Objective To determine the effect of NADT on patient’s long-term recovery following surgery. Design, setting, and participants From March 2011 to August 2013, 5808 men with newly diagnosed prostate were followed up to 24 mo. A cohort of men who received NADT prior to robotic-assisted laparoscopic prostatectomy (RALP; n = 51) was compared 1:3 with a matched group that underwent RALP only (n = 153). Outcome measurements and statistical analysis Patients were matched on Charlson comorbidities, biopsy Gleason score, and node status on final pathology. The Kruskall-Wallis test was used to compare the groups on their bowel, urinary, sexual, and hormonal domains of the 26-item Expanded Prostate Cancer Index Composite at baseline and at 1, 3, 6, 12, 18, and 24 mo postoperatively. Results and limitations The urinary irritative, urinary incontinence, and bowel domains were similar in the two groups during the 24 mo (p = 0.832, 0.901, and 0.732, respectively). In the hormonal domain, the NADT group did worse (p Conclusions Patients who received NADT prior to RALP do not have worse sexual function, but have worse hormonal scores for up to 2 yr after surgery. Patient summary Neoadjuvant androgen deprivation therapy (NADT) is administered prior to robotic-assisted laparoscopic prostatectomy (RALP), contrary to clinical guidelines. NADT may not have worse sexual function outcomes up to 2 yr after RALP.