AB140. Efficacy of radical prostatectomy combined with neoadjuvant chemotherapy in the treatment of locally advanced prostate cancer: preliminary experiences from a single center

Objective: To investigate the clinical efficacy of retropubic radical prostatectomy subsequent to neoadjuvant chemotherapy and neoadjuvant hormonal therapy in the treatment of local advanced prostate cancer and to evaluate its adverse effects and tolerance.

Methods: Fourteen patients with local advanced prostate cancer from Feb. 2015 to Jan. 2016 were firstly given three cycles of neoadjuvant chemotherapy combined with neoadjuvant hormonal therapy (the 21 days regimen of docetaxel plus prednisone combined with goserelin acetate 3.6 mg/28 d), after that, retropubic radical prostatectomy with extended pelvic lymph node dissection was performed. The extent of extended lymph node dissection includes lymph nodes near external iliac vessel, obturator, internal iliac vessel and common iliac artery. The clinical features and short-term efficacy of these patients were investigated prospectively. All patients excluded severe medical complications, bone metastasis, visceral metastasis, and their life expectancy >10 years. Recording their age, initial clinical stage, initial Gleason grade, initial PSA value, PSA value after neoadjuvant therapy, operative time, blood loss volume during operation, postoperative pathological stage, lymph node metastasis status, PSA value at 1 month after operation, PSA value at 3 month after operation and the recovery time of urinary continence. Only using 0–1 pad/24 h is the criterion of continence recovery.

Results: The average age of 14 patients was 64.3 (range, 58–72) years. One of whose Gleason score was 3+3=6, two of whose Gleason score were 3+4=7, four of whose Gleason score were 4+3=7, one of whose Gleason score was 5+3=8, two of whose Gleason score were 5+4=9. The mean PSA value before combined neoadjuvant therapy was 72.6 (range, 55.8–119) ng/mL. Seven of whose clinical stage were cT3bN0M0, two of whose clinical stage were cT3bN1M0, three of whose clinical stage were cT4N0M0, two of whose clinical stage were cT4N1M0. Neutropenia (neutrophil count <2.0×10⁹/L) occurred in 11 patients during the time of combined neoadjuvant therapy, all of them recovered after treated by G-CSF; hepatic impairment occurred in one patient who underwent two cycles of DP chemotherapy regimen, the patient’s liver function recovered after liver-protecting treatment and then went on the 3th cycle of DP regimen for continued treatment. One patient’s date of surgery (radical prostatectomy) was brought forward after two weeks of combined neoadjuvant therapy for severe gastrointestinal reaction. The mean preoperative PSA value dropped to 2.7 (range, 0.48–7.66) ng/mL after combined neoadjuvant therapy. The mean operative time was 138 (range, 96–185) min, mean blood loss volume during operation was 314 (range, 120–650) mL, there were no severe complications like rectal injury and great vascular injury during operation. Five of whose postoperative pathological stage were pT2c, six of whose postoperative pathological stage were pT3b, three of whose postoperative pathological stage were pT4, six patients’ stage down compared to pre-operation (42.8%). Mean amount of dissected lymph node was 15.3 (range, 10–18), three of whose lymph node been invaded confirmed by pathological examination. Mean follow-up time was 4.7 (range, 1–8) month. Two of whose PSA value at 6 month after operation higher than others’, they were 4.58 and 9.33 ng/mL respectively, and both of these two patients had lymph node invasion. Other twelve of whose PSA value at 6-month after operation upped to the standard of radical treatment, and their mean PSA value was 0.02 (range, 0.01–0.04) ng/mL. Eleven patients followed up for three month, excluded two patients who didn’t up to standard of radical treatment, their mean PSA value was 0.03 (range, 0.01–0.04) ng/mL. Among the eleven patients who had followed up for three month, ten of whom attained complete urinary continence (90.9%).

Conclusions: The therapeutic protocol that combines adjuvant chemotherapy with hormonal therapy is based on the DP regimen and has prominent positive effects including remarkable down-staging effects, well tolerance and low incidence of severe adverse reaction. Radical retropubic prostatectomy subsequent to combined neoadjuvant therapy is characterized as high safety performance and controllable complication, as well as good short-term curative effect. Postoperative pathological examination can verify whether patients have pelvic lymph node metastasis and the positive result indicate poor prognosis. In consideration of the limited number of this research and short follow-up time, it’s necessary to conduct large sample prospective randomized controlled studies in exploring the long-term prognosis of patient who obtain radical retropubic prostatectomy subsequent to combined neoadjuvant treatment further in the future.

Keywords: Locally advanced prostate cancer; docetaxel; retropubic radical prostatectomy; neoadjuvant chemotherapy