The PROTEUS trial, a multicenter phase 3 randomized controlled study, demonstrated that adding a second androgen-receptor pathway inhibitor to standard ADT both before and after radical prostatectomy reduced biochemical recurrence risk by approximately 30% versus single-agent ADT in high-risk localized disease. This builds on earlier observational cohorts and smaller RCTs showing modest benefits from neoadjuvant ADT alone, yet PROTEUS stands out for its size (over 500 patients) and rigorous endpoint adjudication. While STAT highlights oncologist enthusiasm, including Antonarakis’s NEJM editorial labeling it watershed, coverage underplays potential conflicts: several investigators disclosed ties to the sponsoring pharmaceutical firms. Long-term overall survival data remain immature, and quality-of-life decrements from intensified hormone exposure—hot flashes, bone density loss, metabolic effects—were not fully detailed. Cross-referencing with the 2022 Lancet Oncology meta-analysis of perioperative ADT trials reveals consistent relapse reduction but heterogeneous toxicity reporting, underscoring need for patient-level shared decision tools. If validated in real-world registries, this regimen could narrow the longstanding gap between surgery and radiation-plus-hormone pathways.