Introduction: Prostate cancer is one of the most common malignancies in men worldwide, with early detection and effective treatment playing a crucial role in patient outcomes. Neoadjuvant androgen deprivation therapy (ADT) has been proposed to reduce tumor burden before radical prostatectomy, potentially improving surgical and pathological outcomes. However, the long-term impact of ADT on disease progression remains under investigation. Objective: To evaluate the effects of an eight-month neoadjuvant ADT regimen on serum PSA levels, testosterone suppression, tumor pathology, and postoperative outcomes in patients undergoing radical prostatectomy. Methodology: A prospective cohort study was conducted at a tertiary care hospital, enrolling 50 patients with localized prostate cancer (T1c–T3a). Patients received an eight-month ADT regimen consisting of a luteinizing hormone-releasing hormone (LHRH) agonist and an anti-androgen. Serum PSA and testosterone levels were monitored monthly. After ADT completion, radical prostatectomy was performed, and pathological outcomes, including tumor stage, positive surgical margins, and lymph node involvement, were analyzed. Statistical analysis was performed using SPSS version 25, with significance set at p<0.05. Results: The mean baseline PSA level was 12.5 ng/mL, which decreased significantly to 0.7 ng/mL after eight months of ADT. Testosterone levels declined from 15.4 nmol/L to 0.3 nmol/L, confirming effective androgen suppression. Postoperative pathology showed organ-confined disease (pT2) in 70% of cases, extraprostatic extension (pT3a) in 20%, and seminal vesicle invasion (pT3b) in 10%. Positive surgical margins were observed in 12% of patients. Conclusion: Neoadjuvant ADT effectively reduces PSA and testosterone levels, leading to significant tumor downstaging. A high percentage of patients had organ confined disease post-treatment, with a low rate of positive surgical margins. These findings suggest that ADT may enhance surgical outcomes in prostate cancer patients, though further studies are needed to assess long-term recurrence and survival benefits.