| ObjectiveTo assess the safety and efficiency of radical prostatectomy(RP) combining with neoadjuvant hormonal therapy(NHT) with for the treatment of T3bN0M0period prostate cancer.MethodRetrospective analysis of136prostate cancer patients in3bNOM0period and were treated in department of urology of Shandong Provincial Hospital from10th January2008to20th May2013. According to the different methods of treatment, the136prostate cancer patients can be divided into the following three groups: The patients treated by retropublic radical prostatectomy combining with neoadjuvant hormonal therapy(NHT) as the regimen of maximal androgrn blockage(MAB) for3months were assigned in group NHT (n=54); the patients who were identified to cT2period by clinical diagnosis, but actually were T3b period confirmed by pathologic results after the retropublic radical prostatectomy were assigned in group RP(n=38); the patients were treated by hormonal therapy(MAB) simply without prostatectomy were assigned in group MAB(n=44). Both NHT and RP were continual treated by postoperative hormonal therapy as MAB. The differences of general conditions among the three groups before treatment including age, prostate volume, the level of PSA and Gleason score was statistically insignificant(p>0.05). By analysing with these variables between NHT and RP patients comparatively, such as operation time, blood loss, positive rate of surgical margin, indwelling catheter time, continent recovery time, we evaluate the effect of NHT before prostatectomy. Meanwhile, comparisons of three groups of patients within2-years and5-years PSA-free survival rate, disease-specific survival rate and the overall survival rate(OST)were also carried out by periodic outpatient, home visit and telephone.ResultsAll surgeries were performed successfully. The average operation time, blood loss, positive surgical margin, indwelling catheter time of NHT group were (102.22±16.55)min,(383.33±50.53) ml,20.37%,(16.72±7.39)d respectively. The corresponding value of RP group were(96.03±17.08)min,(325.26±75.45)ml,36.84%,(17.34±6.49)d. Except for blood loss(p=0.022), there was no significant differences between these2groups with regard to operation time(p=0.378), indwelling catheter time(p=0.678). The following-up time was15-60months, except for3cases uroclepsia(2cases in NHT,1case in RP), the average time of urinary continence were (55.67±13.72)d,(60.84±15.17) d(p=0.01)respectively in NHT and RP.2cases of urethrostenosis,1case surgical incision infection,1case fat liquefaction in NHT group,1case of urethrostenosis,1case surgical incision infection,1case lymphatic fistula,2cases rectal injury in RP group. The2-years and5-years PSA-free survival were (97.3%and87.04%) in NHT,(89.48%and68.43%) in RP,(90.91%and70.46%) in MAB(2-year p=0.104,5-year p=0.036). The2-years and5-years local recurrence-free survival between NHT and RP groups:100%and96.3%for NHT versus97.37%and86.85%for RP(2-year p=0.364,5-year p=0.025).The5-years disease-free survival were98.15%,86.84%and84.10%(p=0.028)in group NHT, RP and MAB respectively. However,5-years overall survival of three groups were not significantly different(p=0.099). ConclusionRadical prostatectomy combined with neoadjuvant hormonal therapy in the treatment of T3bN0M0period prostate cancer is safe and effective, NHT didn’t increase prostate cancer patients’operation risk and also reduces positive margin rates and blood loss,meanwhile,it not only can improves5-year PSA-free survival rates but also improve5-year disease-free survival rates significantly,especially for medium and low risk prostate cancer patients. |
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