Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Jpn J Clin Oncol. 2020 Jan 24;50(1):66-72. doi: 10.1093/jjco/hyz138.
Patients with advanced high-risk prostate cancer (PCa) are prone to have worse pathological diagnoses of positive surgical margins and/or lymph node invasion, resulting in early biochemical recurrence (BCR) despite having undergone radical prostatectomy (RP). Therefore, it is controversial whether patients with high-risk PCa should undergo RP. The purpose of this study was to evaluate the efficacy of neoadjuvant chemohormonal therapy (NAC) followed by "extended" RP.
A total of 87 patients with high-risk PCa prospectively underwent extended RP after NAC; most of the patients underwent 6 months of estramustine phosphate (EMP) 140 mg twice daily, along with a luteinizing hormone-releasing hormone agonist/antagonist. We developed our surgical technique to reduce the rate of positive surgical margins. We aimed to approach the muscle layer of the rectum by dissecting the mesorectal fascia and continuing the dissection through the mesorectum until the muscle layer of the rectum was exposed.
More than 1 year had elapsed after surgery in all 86 patients, with a median follow-up period of 37.7 months. The 3-year BCR-free survival was 74.9%. Multivariate Cox-regression analysis revealed that a positive core ratio of 50% or greater and pathological stage of pT3 or greater were independent predictors for BCR. About 17 of 23 cases received salvage androgen deprivation therapy and concurrent external beam radiotherapy, and showed no progression after the salvage therapies.
NAC concordant with extended RP is feasible and might provide good cancer control for patients with high-risk PCa.
患有晚期高危前列腺癌（PCa）的患者更容易出现阳性手术切缘和/或淋巴结侵犯的病理诊断，导致尽管接受了根治性前列腺切除术（RP），仍出现早期生化复发（BCR）。因此，高危 PCa 患者是否应接受 RP 存在争议。本研究旨在评估新辅助化疗联合激素治疗（NAC）后行“扩展”RP 的疗效。
共 87 例高危 PCa 患者前瞻性接受 NAC 后行扩展 RP；大多数患者接受了 6 个月的磷酸雌二醇氮芥（EMP）140mg 每日两次，同时使用促黄体激素释放激素激动剂/拮抗剂。我们开发了手术技术以降低阳性手术切缘的发生率。我们的目标是通过解剖直肠系膜筋膜并通过直肠系膜继续解剖，直至暴露直肠肌肉层来接近直肠肌肉层。
86 例患者术后均随访超过 1 年，中位随访时间为 37.7 个月。3 年 BCR 无复发生存率为 74.9%。多因素 Cox 回归分析显示，核心阳性率≥50%和病理分期 pT3 或更高是 BCR 的独立预测因素。23 例中有 17 例接受了挽救性雄激素剥夺治疗和同步外照射放疗，挽救治疗后无进展。
与扩展 RP 一致的 NAC 是可行的，可为高危 PCa 患者提供良好的肿瘤控制。
