Patients with high-risk prostate cancer treated with curative intent are at an increased risk of biochemical recurrence, metastatic progression and cancer-related death compared with patients treated for low-risk or intermediate-risk disease. Thus, these patients often need multimodal therapy to achieve complete disease control. Over the past two decades, multiple studies on the use of neoadjuvant treatment have been performed using conventional androgen deprivation therapy, which comprises luteinizing hormone-releasing hormone agonists or antagonists and/or first-line anti-androgens. However, despite results from these studies demonstrating a reduction in positive surgical margins and tumour volume, no benefit has been observed in hard oncological end points, such as cancer-related death. The introduction of potent androgen receptor signalling inhibitors (ARSIs), such as abiraterone, apalutamide, enzalutamide and darolutamide, has led to a renewed interest in using neoadjuvant hormonal treatment in high-risk prostate cancer. The addition of ARSIs to androgen deprivation therapy has demonstrated substantial survival benefits in the metastatic castration-resistant, non-metastatic castration-resistant and metastatic hormone-sensitive settings. Intuitively, a similar survival effect can be expected when applying ARSIs as a neoadjuvant strategy in high-risk prostate cancer. Most studies on neoadjuvant ARSIs use a pathological end point as a surrogate for long-term oncological outcome. However, no consensus yet exists regarding the ideal definition of pathological response following neoadjuvant hormonal therapy and pathologists might encounter difficulties in determining pathological response in hormonally treated prostate specimens. The neoadjuvant setting also provides opportunities to gain insight into resistance mechanisms against neoadjuvant hormonal therapy and, consequently, to guide personalized therapy.

与接受低危或中危疾病治疗的患者相比，接受治愈性治疗的高危前列腺癌患者生化复发、转移进展和癌症相关死亡的风险增加。因此，这些患者通常需要多模式治疗以实现完全的疾病控制。在过去的二十年里，使用传统的雄激素剥夺疗法进行了多项关于新辅助治疗的研究，其中包括促黄体激素释放激素激动剂或拮抗剂和/或一线抗雄激素。然而，尽管这些研究的结果表明阳性手术切缘和肿瘤体积有所减少，但在硬肿瘤学终点（例如癌症相关死亡）方面没有观察到任何益处。引入强效雄激素受体信号抑制剂 (ARSI)，如阿比特龙、阿帕鲁胺、恩杂鲁胺和达洛鲁胺，重新引起了人们对在高危前列腺癌中使用新辅助激素治疗的兴趣。将 ARSI 添加到雄激素剥夺疗法已证明在转移性去势抵抗、非转移性去势抵抗和转移性激素敏感环境中具有显着的生存益处。直觉上，将 ARSI 作为新辅助治疗策略用于高危前列腺癌时，可以预期类似的生存效果。大多数关于新辅助 ARSI 的研究使用病理学终点作为长期肿瘤学结果的替代指标。然而，关于新辅助激素治疗后病理反应的理想定义尚无共识，病理学家在确定激素治疗的前列腺标本的病理反应时可能会遇到困难。新辅助治疗还提供了深入了解新辅助激素治疗耐药机制的机会，从而指导个性化治疗。