To evaluate the impact of neoadjuvant hormonal therapy (NHT) combined with robotic-assisted laparoscopic radical prostatectomy (RARP) on postoperative urinary continence recovery compared to RARP alone in patients with localized prostate cancer.

A multicenter retro-prospective cohort study was conducted involving 2,453 patients treated between November 2018 and November 2023 at four tertiary hospitals in China. After applying exclusion criteria, 1,927 patients who completed one-year follow-up were included (760 NHT+RARP, 1,167 RARP alone). Propensity score matching (1:1) was performed based on age, prostate volume, body mass index, preoperative PSA level, surgical approach, and pathological T stage, resulting in 249 matched pairs. Urinary continence was defined as using no pad or one safety pad per day and assessed via standardized questionnaires during follow-up visits.

The NHT group demonstrated significantly better urinary continence recovery compared to the control group (P<0.001). Median recovery times were 8 weeks (95% CI: 13.61-17.70) for the NHT group and 16 weeks (95% CI: 18.34-23.01) for the control group. Early continence rates (2-12 weeks) were significantly higher in the NHT group (42.2% vs. 24.5%, P<0.001). Multivariate Cox regression analysis identified NHT (HR=1.273, 95% CI: 1.063-1.525, P=0.009) and age (HR=0.968, 95% CI: 0.955-0.980, P<0.001) as independent predictors of urinary continence recovery.

Preoperative NHT was associated with significantly improved postoperative urinary continence recovery after RARP, including faster recovery time and higher early continence rates. These findings suggest that NHT may provide functional benefits beyond its established oncological effects in prostate cancer treatment.