Konety Badrinath R, Eastham James A, Reuter Vicor E, Scardino Peter T, Donat S Machele, Dalbagni Guido, Russo Paul, Herr Harry W, Schwartz Larry, Kantoff Philip W, Scher Howard, Kelly W Kevin
Department of Urology, Memorial Sloan-Kettering Cancer Center and Cornell University, New York, New York 10021, USA.
J Urol. 2004 Feb;171(2 Pt 1):709-13. doi: 10.1097/01.ju.0000108122.36893.5a.
We determined the feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy in locally advanced (stage T3 or greater) and/or high risk tumors (Gleason 8 to 10 and/or serum prostate specific antigen (PSA) greater than 20 ng/ml).
Enrollment criteria included clinical stage T1 to 2 with any Gleason grade and PSA greater than 20 ng/ml, clinical stage T3 to 4 with any serum PSA or Gleason grade, or any clinical stage with biopsy Gleason grade of 8 to 10 and any serum PSA. All patients received neoadjuvant hormonal therapy during chemotherapy (4 cycles of paclitaxel and carboplatin and estramustine) followed by radical prostatectomy. Nerve sparing was decided on an individual basis and a nerve graft was offered to those who underwent unilateral or bilateral nerve resection. Perioperative morbidity, mortality and delayed complications were assessed.
A total of 36 patients were enrolled. After chemohormonal therapy clinical stage was less in 39% of patients and greater in 36%. Bilateral nerve sparing was performed in 3 patients and the remaining 33 underwent either unilateral or bilateral neurovascular bundle resection with nerve grafts performed in 17 (52%). Deep vein thrombosis (22%) was the most frequent complication of chemotherapy. Minor postoperative complications occurred in 6 patients. At a median followup of 29 months (range 5 to 51) after radical prostatectomy 32 (89%) were continent and 5 (15%) preoperatively potent men remained potent. The positive surgical margin rate was 22%. Of all subjects 45% remain free from biochemical recurrence.
Neoadjuvant chemohormonal therapy followed by radical prostatectomy can be performed with low morbidity. Positive surgical margin rates are low. This approach yielded good local control of disease, however impact on tumor recurrence and survival is not known.
我们确定了在局部晚期（T3期或更高）和/或高危肿瘤（ Gleason评分8至10分和/或血清前列腺特异性抗原（PSA）大于20 ng/ml）患者中，新辅助放化疗后行根治性前列腺切除术的可行性。
纳入标准包括：任何Gleason分级且PSA大于20 ng/ml的临床T1至2期患者；任何血清PSA或Gleason分级的临床T3至4期患者；或任何临床分期且活检Gleason分级为8至10分及任何血清PSA水平的患者。所有患者在化疗（4周期紫杉醇、卡铂和雌莫司汀）期间接受新辅助激素治疗，随后行根治性前列腺切除术。神经保留根据个体情况决定，对于接受单侧或双侧神经切除的患者提供神经移植。评估围手术期发病率、死亡率和延迟并发症。
共纳入36例患者。新辅助放化疗后，39%的患者临床分期降低，36%的患者临床分期升高。3例患者行双侧神经保留，其余33例患者行单侧或双侧神经血管束切除，其中17例（52%）进行了神经移植。深静脉血栓形成（22%）是化疗最常见的并发症。6例患者出现轻微术后并发症。根治性前列腺切除术后中位随访29个月（范围5至51个月），32例（89%）患者控尿良好，5例（15%）术前有性功能的男性仍有性功能。手术切缘阳性率为22%。所有受试者中45%无生化复发。
新辅助放化疗后行根治性前列腺切除术可在低发病率情况下进行。手术切缘阳性率较低。这种方法对疾病有良好的局部控制，然而对肿瘤复发和生存的影响尚不清楚。
