Clinical Study Of Neoadjuvant Endocrine Therapy Combined With Laparoscopic Radical Prostatectomy In The Treatment Of High-risk Prostate Cancer

Objective:To explore the efficacy and safety of neoadjuvant endocrine therapy combined with laparoscopic radical prostatectomy in patients with high-risk prostate cancer.Methods:From January 2018 to December 2020,82 cases of high-risk prostate cancer diagnosed by pathology after puncture in our hospital were divided into experimental group and control group.51 cases in the control group were treated with laparoscopic radical prostatectomy,and 31 cases in the experimental group were treated with NHT for 2-12 months,followed by laparoscopic radical prostatectomy.Combined with outpatient data,hospitalization data and telephone follow-up information,the relevant data were collected,and the efficacy of neoadjuvant endocrine therapy was evaluated by comparing the changes of prostate volume,Gleason score,TNM stage and PSA before and after neoadjuvant endocrine therapy in the experimental group.At the same time,the operation time,average intraoperative blood loss,rectal injury rate,incisal margin positive rate,lymph node positive rate,seminal vesicle infiltration rate,capsule invasion rate,postoperative hospital stay,drainage tube indwelling time,catheter indwelling time,anastomotic fistula rate,complete urine control rate,biochemical recurrence rate,distant metastasis and local progression were compared between the two groups.To evaluate the clinical value of neoadjuvant endocrine therapy in the treatment of high-risk prostate cancer.Results:All 82 high-risk prostate cancer patients completed the operation successfully.There were 51 cases in the control group,with an average age of66.10±5.49 years old;BMI 23.97±2.35 kg/㎡;first visit PSA 36.78±30.06(ng/ml);first visit prostate volume 54.30±32.67 ml;puncture Gleason score7.57±0.96.There were 31 cases in the experimental group,with an average age of 66.52±5.27 years;BMI 24.53±3.52 kg/㎡;first visit PSA 38.0±31.71(ng/ml);first visit prostate volume 49.07±20.52 ml;puncture Gleason score 8.03±1.14,enrolled in the group There was no significant difference in the data(P>0.05).In the preoperative TNM staging of the control group,20 cases were in T2 c stage,accounting for 39.22%;followed by T2 b stage 12 cases accounting for 23.53%;T3a stage 11 cases accounting for 21.57%;T2a stage 6 cases accounting for 11.76%;T3b stage 2 cases accounting for 3.92%,0 cases in T4 stage.The preoperative TNM staging of the experimental group was still T2 c stage,up to 16 cases accounted for 51.61%;followed by T3 b stage 6 cases accounted for 19.35%,including 1 suspected lymph node metastasis,T2 b stage 3 cases accounted for 9.68%;T4 stage 1 case accounted for 3.23 % Suspected violation of the bladder neck.After 2-12 months of neoadjuvant endocrine therapy in the experimental group,PSA decreased significantly from 38.0±5.70 ng/ml to 0.254±0.042ng/ml,the difference was statistically significant;prostate volume was significantly reduced(P<0.001),49.07±3.69 ml before treatment,42.54±3.28 ml after treatment;Gleason score showed an upward trend of 8.03±0.20 points before treatment,and 8.19±0.22 points after treatment,there was no statistically significant difference.In terms of clinical staging,16 cases in T2 c stage,3 cases decreased to T2b;3 cases in T3 a stage,1 case decreased to T2c;6 cases in T3 b stage,1 case decreased to T3 a,and 1 case decreased to T2 c.The Gleason score also changed partly.Among them,the scores increased in 4cases,of which 3 cases increased from 4+3=7 points to 4+5=9 points,and 1case increased from 4+4=8 to 4+5= 9 points;there are 3 cases where the score drops,4+5=9 points drop to 4+4=8 points,4+3=7 points drop to 3+3=6 points,3+4=7 points drop to 3+3 = 6 points.The comparison of the perioperative data between the control group and the experimental group is as follows: the average operation time was 171.53±43.87 min,168.55±33.35min;the average blood loss was 225.49±164.43 ml and 229.35±231.05;the postoperative hospital stay was 4.94±1.76 d,5.06±1.03 d The indwelling time of the drainage tube was 4.75±2.07 d and 4.00±0.63d;the indwelling time of the urinary catheter was 19.62±3.95 d and 18.32± 3.40 d,respectively,there was no significant difference(P>0.05).Postoperative rectal injury occurred in 1 case in the control group.Due to the close relationship between the prostate and rectum,an intestinal fistula occurred after the operation.Laparoscopic exploration + rectal stoma was performed.The postoperative follow-up was 1 year,and the recovery was acceptable without tumor recurrence.The positive rate of resection margin,seminal vesicle infiltration and capsular invasion after operation were lower in the experimental group than in the control group,which were 22.58% VS27.45%;16.13% VS 17.65%;7.84% VS 6.45%,but the difference was not statistically significant.Significance: The positive rate of lymph nodes in the experimental group was 12.90% VS 9.80% higher than the control group,but it was not statistically significant;there was no anastomotic leakage in the two groups.Postoperative follow-up showed that 51 cases in the control group had a follow-up time of 4 to 36 months with a median follow-up time of 20 months;31 cases in the experimental group had a follow-up time of 6 to 32 months with a median follow-up time of 15 months.After three months after the operation,the results of the control group and the experimental group were66.67% vs 58.06%.There was 1 case in the control group and 2 cases in the experimental group with persistent urinary incontinence.The biochemical recurrence rate of the experimental group was 6.45%vs9.80% lower than that of the control group,and the difference was not statistically significant.Distant metastasis and local progression,1 case in the control group accounted for 1.96%,but no cases in the experimental group.Conclusions:1.Neoadjuvant endocrine therapy combined with laparoscopic radical prostatectomy for high-risk prostate cancer patients is safe and effective,does not increase the difficulty of surgery and the incidence of complications,can significantly reduce PSA levels,reduce prostate volume,and reduce tumor staging,so that patients Get an opportunity for surgery.2.Neoadjuvant endocrine therapy combined with laparoscopic radical prostatectomy can reduce the positive rate of resection margins,seminal vesicle infiltration and capsular invasion,reduce rectal injury without increasing the incidence of urinary incontinence.The postoperative biochemical recurrence rate,distant metastasis and local progression rate were lower than those of the control group but there was no statistically significant difference.