Genomic Biomarker-guided Neoadjuvant Therapy for Prostate Cancer (SEGNO)

This study tests whether genetic profiling of prostate cancer can guide which combination of hormone therapy drugs works best before surgery in men with locally advanced or limited-spread prostate cancer. The goal is to shrink the tumor before removing it. **You may be eligible if...** - You are male and 18 or older - Imaging has confirmed locally advanced or limited-spread (up to 5 bone sites) prostate cancer - You have not had bone or organ spread beyond those limits - You have not previously been treated for prostate cancer (short hormone therapy up to 28 days is allowed) - You are fit enough for surgery after the treatment period - You agree to genetic testing and contraception requirements during the study **You may NOT be eligible if...** - You have had brain metastases or epilepsy - You have had a heart attack, severe heart failure, or uncontrolled high blood pressure - You have had prostate surgery or radiation before - You have HIV, active hepatitis B, or untreated hepatitis C - You have other active cancers requiring treatment Talk to your doctor to see if this trial is right for you.