PC 05. Neoadjuvant hormonal therapy and robot assisted laparoscopic radical prostatectomy in the treatment for high-risk prostate cancer

Objective: To analyse the efficacy and safety of neoadjuvant hormonal therapy (NHT) and robot-assisted laparoscopic radical prostatectomy (RALRP) in the treatment for high-risk prostate cancer.

Methods: From March 2010 to June 2011, 5 patients diagnosed high-risk prostate cancer were admitted to our department, of which, 2 cases were T3a, 3 were T3b. The age was 53-74 years. Gleasson score was 7 in 4 cases and 6 in the other cases. PSA >20 ng/mL was found in all cases. Neoadjuvant hormonal therapy in the form of maximal androgen blockage (MAB) was administrated in all cases (3 months in 3 cases, 5 months in 2 cases), PSA leval was decreased beneath 0.2 ng/mL before RALRP was performed.

Results: The perioperative course was uneventful. The operating time was 220-270 minutes (the average docking time was 15 minutes and was included), the blood loss was 500-800 mL. The drainage tube was withdrawn 72 hours postoperatively and urinary leakage was not identified. A pathological diagnosis of Gleasson 6 was reported in 3 cases with a negative margin, and tumor cell could not found in the remaining 2 cases. The follow-up was 6-21 months, and PSA less than 0.2 ng/mL was maintained in all cases without adjuvant hormonal therapy. No local recurrence and metastasis was identified in any case. Only 1 patient suffered from mild stress urinary incontinence 6 months postoperatively. 3 patients with a normal preoperative erectile function were satisfied with the postoperative erectile status after 6 months of RALRP.

Conclusions: For patients of high-risk prostate cancer selecting RALRP, NHT could be considred to achieve staging degradation and elongate the time to PSA relapse.