Impact of Neoadjuvant Androgen Deprivation Therapy on Urinary Continence and Longitudinal Quality of Life After Robot-Assisted Radical Prostatectomy

Objective: Neoadjuvant androgen deprivation therapy (ADT) is commonly administered before robot-assisted radical prostatectomy (RARP) in selected patients with localized prostate cancer, particularly those with high-risk disease. Despite its potential oncologic benefits, the association of neoadjuvant ADT with postoperative urinary function and health-related quality of life remains unclear. Therefore, this study aims to evaluate the association between neoadjuvant ADT and functional recovery following RARP.

Methods: Consecutive patients who underwent RARP between January 1, 2022, and December 31, 2024, were retrospectively reviewed and categorized based on neoadjuvant ADT status. Urinary continence (≤1 pad/d), Expanded Prostate Cancer Index Composite urinary domain score, Functional Assessment of Cancer Therapy— General score, and Functional Assessment of Cancer Therapy—Prostate score were assessed longitudinally. Urinary continence recovery was analyzed using the Kaplan– Meier method, and longitudinal patient-reported outcomes were evaluated using linear mixed-effects models.

Results: Among 327 eligible patients, 58 received neoadjuvant ADT. Urinary continence recovery was comparable between the groups (log-rank P = .251). Expanded Prostate Cancer Index Composite urinary domain scores decreased immediately after surgery and improved over time (P for time <.001). Neoadjuvant ADT (P = .181) and the time-by-treatment interaction (P = .557) were not significantly associated with postoperative urinary function. Similarly, longitudinal Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Prostate scores were comparable between the groups.

Conclusion: Neoadjuvant ADT is not associated with delayed urinary continence recovery or poorer health-related quality of life after RARP, supporting its use in appropriately selected patients without evidence of compromised postoperative functional recovery.

Cite this article as: Taniguchi H, Ikeda J, Masuo Y, Kinoshita H. Impact of neoadjuvant androgen deprivation therapy on urinary continence and longitudinal quality of life after robot-assisted radical prostatectomy. Urol Res Pract. 2026;52, doi: 10.5152/tud.2026.26026