Neoadjuvant strategies before radical prostatectomy for high risk prostate cancer in the era of new hormonal agents

Prostate cancer (PCa) is a hormone dependent disease including several different patterns from indolent and clinically meaningless to aggressive and lethal disease. Among non-metastatic PCa, high-risk disease represents a therapeutically challenge, given the unfavorable oncological outcomes after exclusive local therapy. Deprivation therapy in the neoadjuvant setting is not recommended prior to radical prostatectomy since it did not provide any survival advantage, although reducing tumor volume, surgical margins rate, local and nodal stage. However, in the few recent years, new hormonal treatments for metastatic PCa emerged, and showed a relevant increase of overall survival with respect to classical androgen deprivation therapy (ADT). Thus, neo-adjuvant regimens of ADT based on these novel molecules are now under investigation and the results of ongoing clinical trials are expected in order to provide a definitive answer on the real role of neoadjuvant hormonal therapy in the treatment of high-risk localized prostate cancer. In this narrative review, we underline the role of neoadjuvant therapy before radical prostatectomy in high-risk PCa patients considering the impact of the new available hormonal agents.