| Objective: By comparing the tumor control efficacy of LRP + endocrine therapy and endocrine therapy, and observing the perioperative parameters of LRP, we found that LRP was a safe and effective choice of treating local high risk prostate cancer. The long time oncological outcomes of LRP remained to be seen.Methods: The clinical and pathological data of 45 patients treated in the department of urology at Tangshan Workers’ Hospital between Jan 2008 to Dec 2014 were retrospectively studied. 45 cases were divided into two groups: the LRP group and the transurethral prostatectomy followed by post-operative hormone therapy group.Patients of both groups were diagnosed with prostate cancer based on pre or post-operative pathological results. The clinical data of patients include the general condition of the patients, surgery time, blood loss during surgery, indwelling catheter time, the instant control urination, the biopsy results of tumor, the post-operative pathological result, the serum PSA level before and after surgery, the clinical stage, Gleason score, the time of biochemical recurrence after radical prostatectomy and the time of serum PSA level above 0.2 ng/ml, etc.Results: All of the 15 cases underwent LRP with pre-operative biopsy results confirmed prostate cancer and post-operative adjuvant hormone therapy. 30 cases underwent endocrine therapy,which was confirmed prostate cancer pathologically. Post-operative adjuvant hormone therapy was carried out in all the cases.All LRP procedures were successful without any conversion to open surgery. The clinical data between the two groups were not significantly different. Among the 15 cases undergoing LRP, the rate in positive surgical was 13.33%(2 cases with positive margin),the mean surgery time was 210±43min, the mean blood loss was 200±60ml, the mean time of extraction of suprapubic drainage tube 6.4±1.05 d and the mean time of extraction of the urethral catheter 21.25±3.54 d, the mean restoration time of bowel functions was 2.68±0.53 d,2 patients got transfusion of 2u and 4u respectively during operation and 2 patients need blood transfusiom of 2u and 4u respectively after surgery.No acute bleeding, rectal injury or urinary fistula happened during or after surgery.3 of the 15 cases in the LRP group got instant urinary control after the extraction of the urethral catheter and another 3 cases got complete urinary control 3 months after surgery(20%). After postoperative sphincter exercise, a total of 11(73.3%) cases got complete urinary control. Among the 15 cases undergoing LRP,no one received endocrine therapy after operation 1week,7 patients after 1~2 weeks(46.67%), 5 patients after 2~4 weeks(33.33%)and 3 patients after 4 weeks(20%). The indication for endocrine therapy included :patients with high risk factors before operation;patients with residual tumors during surgery;patients with positive surgical margins;the levels of PSA before or after surgery.The PSA levels between the two groups were not significantly different(P>0.05). The levels and drops of PSA after surgery 1 week between LRP group(without endocrine therapy) and endocrine therapy group had statistical significance(P<0.05). The levels and drops of PSA after surgery 6 months between two groups(with endocrine therapy) also had statistical significance(P<0.05).The length from surgery to PSA<0.2ng/m L in two groups was significantly different(P<0.05) and the time of duration that PSA was below 0.2ng/m L in LRP group was longer than endocrine therapy group(P<0.05), which suggested the levels of PSA was lower and the ability of tumour sppression was stronger in LRP group. Our study may to some extent be hepful to evoluate the prognosis of prostate cancer patients,however,more prospective sudies will be needed to provide theoretical foundation for clinical work.Conclusion: Extraperitoneal laparoscopic radical prostatectomy comb- ined with post-operative adjuvant therapy is a safe, effective, minimal invasive way of treating high risk prostate cancer with quick recovery and little complications. The biochemical recurrence free survival rate and cancer specific survival rate of patients can also be increased. |
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