Neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy has been advocated for downstaging of tumors and reducing the rates of positive surgical margins with the expectation that disease-free survival will be improved. Despite the apparent favorable impact on pathologic findings, randomized trials to date show no benefit of NHT in prostate-specific antigen progression rates. Consequently, there is serious concern about the validity and biologic significance of the apparent downstaging and decreased rate of positive margins, and no evidence exists that there is improved time to progression and survival; therefore, the authors do not recommend NHT outside of a clinical trial.