Therapeutic Effect Of Different Neoadjuvant Endocrine Therapy Period Combined With Robot-assisted Laparoscopic Radical Prostatectomy For Locally Advanced Prostate Cancer

Objective: To explore the therapeutic effect of robot-assisted radical prostatectomy in different neoadjuvant endocrine therapy period of locally advanced prostate cancer.Methods: Patients with prostate cancer who were admitted to our hospital from 2016-01-01 to 2018-10-01 were diagnosed by a 13-point systemic puncture of the rectal prostate in our hospital under the guidance of B-ultrasound.And undergoing robot-assisted radical prostatectomy in our hospital.Microscopic radical prostatectomy,according to preoperative PSA,Gleason score,urinary color Doppler ultrasound,pelvic MRI/CT,whole body bone scan and pulmonary CT,all patients were diagnosed locally advanced prostate cancer,according to whether the preoperative patient NHT treatment and different NHT cycles were divided into 3 groups,group A did not undergo NHT treatment,group B(short period)for 1 to 3 months of NHT treatment,group C(long period)for 3 to 6 months of NHT Treatment,collection of clinical data including(age,PSA1(pre-treatment PSA),PSA2(PSA after NHT),Gleason score pathological grade difference,postoperative biochemical recurrence rate,prostate volume difference(Prostate volume difference measured by urinary color Doppler ultrasound before and after NHT),postoperative survival;and perioperative data including intraoperative blood loss,HB decline,postoperative hospital stay,postoperative complication rate,transit openness,margin positive rate,postoperative lymph node positive rate,surgery time,postoperative ventilation And the total costs.RESULTS: A total of 71 cases in the three groups,all operations were successfully completed,no intraoperative transfer open.The baseline levels of the three groups before surgery were consistent and comparable.There were no significant differences in the Gleason score,pathological grade difference,total cost,HB decline,operation time,postoperative hospital stay,postoperative lymph node positive rate,ventilation time,and postoperative total complication rate.(P>0.05).Prostate volume difference and PSA2 were significantly better in group C than in group B,which were(23.7± 7.7VS6.2±2.5)(P<0.01),[0.4(1.2)VS1.6(5.9)](P=0.047<0.05);in the intraoperative blood loss,group C had more blood loss than group A and group B [325(150)VS 200(100)VS 200(185)](P<0.05);Postoperative margin positive rate and biochemical recurrence rate of the B group and the C group showed significant advantages compared with the A group.The values of the A,B and C groups were(68.9% vs 38.9% vs 12.5%).(62.2% vs 33.3% vs 25%),but only there was a statistical difference between the A group and the C group(using the corrected test level 0.0167),(The P values between the AC groups are 0.004 and 0.012,respectively,which are less than 0.0167.);no statistical difference was found between the other groups(P>0.0167).Before the follow-up date of March 1,2019,a patient was found to have died in the follow-up,and no deaths were observed in either group B or C.Conclusions: RARP is a safe and effective treatment for LAPC.It has good surgical safety and acceptable postoperative complications.Long-term NHT treatment with shorter period of NHT can reduce PSA value and reduce prostate volume.Long-term NHT treatment combination RARP is a better treatment option for LAPC than RARP alone and short-cycle NHT combined with RARP.