The Analysis Of Clinical Effect To Robot-assisted Radical Prostatectomy Combined With Endocrine Therapy For Oligometastatic Prostate Cancer

Objective:To investigate the safety,feasibility and clinical efficacy of robot-assisted laparoscopic radical prostatectomy(RARP)combined with endocrine therapy for oligometastatic prostate cancer.Methods:A total of 121 patients with oligometastatic prostate cancer admitted to the Department of Urology,the First Affiliated Hospital of Nanchang University from January 2016 to May 2020 were retrospectively analyzed and divided into the study group and the control group according to whether they received robotic surgery or not,in which 61 patients in the study group received RARP combined with endocrine therapy and 60 patients in the control group received endocrine therapy alone.Oligometastatic disease was defined as the presence of five or fewer hot spots detected by preoperative bone scan.The general clinical data,PSA nadir after treatment,castration-resistant prostate cancer(CRPC)-free survival and intraoperative and postoperative clinical data of the study group were collected to analyze the differences in the clinical efficacy between the two groups.Results:The mean age of patients in study group and control group was 68.74 ±6.87 and 73.20 ± 6.97 years,respectively.The patients in study group were younger(P = 0.001).However,there was no significant difference in body mass index(BMI),baseline prostate specific antigen(PSA),Gleason score of needle biopsy,number of bone metastases,clinical stage and other general clinical data.61 patients in study group were successfully completed the operation,with an average operation time of127.93 ± 47.76 min,intraoperative estimated blood loss of 200(200-325)ml,intraoperative blood transfusion in 1(1.6%)patient,and postoperative hospital stay of8(7-10)days.Postoperatively,1(1.6%)patient experienced anastomotic leakage,1(1.6%)patient experienced intestinal obstruction,and 1(1.6%)patient experienced urethral stricture.Fifteen(24.6%)had lymph node metastasis and 41(67.2%)specimens had positive surgical margins.The follow-up time was 32.0(24.0-43.5)months in study group and 39.5(28.0-48.8)months in control group.Compared with control group,study group had significantly improved PSA nadir(0.05 vs 0.09 ng/ml,P = 0.001),CRPC progression rate(32.8% vs 51.7%,P = 0.035)and CRPC-free survival(not reached vs 24 months,P = 0.015).Conclusion:RARP combined with endocrine therapy for oligometastatic PCa is safe and feasible,without serious complications during and after surgery,and can significantly prolong the CRPC-free survival of patients,with a definite short-term effect,and the long-term effect needs further follow-up.