Study On The Correlation Between Laparoscopic Fascia Internal And External Radical Resection And Biochemical Recurrence Of Prostate Cancer In ISUP 2～3 Group

Objective: By collecting patients with localized prostate cancer in ISUP 2～3 groups,the factors such as positive postoperative margin and biochemical recurrence(BCR)between intrafascial and extrafascial operations were compared,so as to provide more suitable surgical methods for patients with localized prostate cancer.Methods: The clinical data and statistical analysis data of postoperative follow-up of85 patients with localized prostate cancer in ISUP 2～3 groups who underwent laparoscopic intrafascial and extrafascial radical prostatectomy in our hospital from January 2016 to December 2021 were retrospectively analyzed.The follow-up time was until the serum PSA level of the patients recurred twice continuously ≥0.2ng/ml,and if not,the patients were followed up until December 2021.Mann-Whitney U test was used to compare and analyze the biochemical recurrence,recurrence time,tumor proportion,preoperative PSA and age difference between the intrafascial group and the extrafascial group.Logistic regression analysis was used to fit the regression model and analyze the influencing factors of recurrence.P<0.05 is statistically significant.Results: Among the 85 patients included in this study,the age of the subjects ranged from 55 to 81 years,with an average age of(70.52 6.33)years.There were 38 cases in ISUP2 group,including 23 cases in intrafascial group,2 cases in biochemical recurrence,13 cases in extrafascial group and 2 cases in biochemical recurrence,with no statistical significance(P=0.609),suggesting that there was no significant difference in biochemical recurrence rate between intrafascial group and extrafascial group among the subjects in ISUP2 group.There were 47 cases in ISUP3 group,including 17 cases in intrafascial group,7 cases in biochemical recurrence,30 cases in extrafascial group and 2 cases in biochemical recurrence.The recurrence rate in the intrafascial group was 77.8% and 22.2% respectively,and the difference was statistically significant(P=0.023).In ISUP2 group,there were 4 cases with positive margin and 3 cases with biochemical recurrence,and in ISUP3 group,there were 8 cases with positive margin and 6 cases with biochemical recurrence.The difference was statistically significant,suggesting that positive margin is an independent risk factor for biochemical recurrence in ISUP2 group and ISUP3 group.Conclusion: The patients with localized prostate cancer in ISUP2 group have good tumor control effect regardless of intrafascial or extrafascial operation,and intrafascial LRP can be recommended for patients with localized prostate cancer in ISUP2 group.Intrafascial surgery for localized prostate cancer in ISUP group 3 also has a certain tumor control effect.Although the biochemical recurrence rate in fascia is higher than that outside fascia,the long-term prognosis of patients with biochemical recurrence will not be affected after comprehensive treatment,and the real recurrence rate is low.For patients with localized prostate cancer in ISUP group 3,we can still recommend intrafascial LRP.Positive margin is an independent risk factor for postoperative biochemical recurrence of localized prostate cancer in ISUP 2～3 groups.