Clinical Efficacy Evaluation Of Robot-assisted Radical Prostatectomy Assisted Radiotherapy For Oligometastatic Prostate Cancer

Objective: To study the clinical efficacy and safety of robot-assisted laparoscopic radical prostatectomy combined with postoperative adjuvant radiotherapy and endocrine therapy for oligometastatic prostate cancer.Methods: Chooses RARP surgery for 100 patients with RARP surgery,the first affiliated hospital in Nanchang University from 2016 to 2021.According to the postoperative treatment,45 cases(ART group)and 55 cases(endocrine group)(endocrine group)(endocrine group)were divided into a secondary(ART group)and the intra-secreted drug treatment group.The ART group was further divided into group A(radiotherapy only for tumor bed)(27 cases)and group B(radiotherapy only for tumor bed and metastasis)(18 cases)according to whether radiotherapy was given to the metastases or not.This study will be defined as OPC in this study.General data of patients in the two groups were collected to compare the lowest level of serum PSA reduction,the survival time of CRPC progression and survival of patients in the two groups after different treatment methods,and the adverse reactions in the ART group were also studied,meanwhile valuate its safety.Results: By data analysis compared the age,BMI,baseline PSA,postoperative Gleason score,number of transition stoves,cutting state,and postoperative pathological staging(P>0.05).The average follow-up time of 100 patients was 39.6months,of which the median follow-up time was 42.1(32.3-50.65)month,and the median follow-up of the endocrine group was 35.2(27.8-49.0)month,the difference was not statistically significant.(P=0.472).The ART group PSA dropped to a minimum of 0.02(0.02-0.035)ng/ml,compared to endocyst group 0.04(0.02-0.1)ng/ml,and the difference was statistically significant(p=0.001).The progress rate of CRPC(17.8% vs 38.2%,P=0.025),the medium-sized non-CRPC progressive time(not reached vs 66.3 months,P=0.034)has significant improvement in patients treated with adjuvant radiotherapy combined with endocrine therapy for primary and metastatic lesions after surgery.There was no significant difference in the survival rate of CRPC progression between the two subgroups(P=0.340),the survival time of CRPC-free progression in group B was significantly higher than that in group A(P=0.035),and there was no significant difference in the survival time of CRPC-free progression in group A and endocrine group(P =0.550).At total survival,no patient death was observed during follow-up,and the survival rate of the two groups was 100%.2(4.4%)of the ART group(4.4%)2-stage gastrointestinal acute toxicity reaction,no 3 and above gastric intestinal acute toxicity response occurred.1case(2.2%)had a three-stage urinary genital pathogenic toxicity reaction,and the acute bladder 2 toxic response rate was 15.5%(7 cases).Anemia occurred in 5 cases(11.1%),leukopenia in 7 cases(15.6%)and hypokalemia in 13 cases(28.9%).Radiotherapy,pathological breakthrough of prostate capsule,Gleason score≥8,metastasis>3 and positive resection margin are the influencing factors for survival time without CRPC progression in patients who have undergone radical prostatectomy.However,the influence of lymph node metastasis on postoperative prostate cancer patients remains to be investigated.After controlling for other variables,the cumulative survival analysis function and risk function of the group with and without radiotherapy showed that the CRPC-free survival of patients with postoperative adjuvant radiotherapy was better than that of patients with endocrine therapy alone,and the cumulative risk was lower.Conclusion: For patients with oligometastatic prostate cancer,postoperative adjuvant radiotherapy combined with endocrine therapy for postoperative tumor beds and metastases can significantly improve the CRPC-free survival rate and CRPC-free progression survival time compared with postoperative endocrine therapy alone.The benefit of tumor bed radiotherapy was only seen in patients with ≤3 metastases.Moreover,the toxicity rate of radiotherapy is low,so it can be considered safe and feasible as an adjunctive therapy for delaying disease progression after radical OPC surgery.Ajuvant Radiotherapy,pathological breakthrough of prostate capsule(>p T2),Gleason score≥8,metastasis>3 and positive resection margin were the influencing factors for survival time without CRPC progression after radical resection.