The Clinical Research Of Cytoreductive Radical Prostatectomy In Treating Oligometastatic Prostate Cancer

Objective:By comparing the effect of cytoreductive radical prostatectomy(CRP)combined with endocrine therapy and simple endocrine therapy in the treatment of oligometastatic prostate cancer(OPC)and observing the perioperative procedure of CRP,to explore the safety and efficacy of CRP in the treatment of oligometastatic prostate cancer.Methods: The clinical and pathological date of 56 patients with oligometastatic prostate cancer treated in our hospital between January 2014 to October 2016 were studied,56 cases were divided into two groups: the CRP group and the endocrine therapy group.All patients were confirmed by prostate biopsy for prostate cancer,and rigorously identified by radiology by the team of experts in this hospital as oligometastatic prostate cancer(OPC).23 cases of CRP group underwent cytoreductive radical prostatectomy and maximal androgen block(MAB)treatment 7 days after surgery supplemented.The age,body mass index,pre-puncture PSA level,operation time,intraoperative blood loss and postoperative pathological findings were collected.The PSA level,postoperative urinary continence and treatment failure time were followed up.There were 33 cases of endocrine therapy group who were treated with maximal androgen block(MAB)immediately after diagnosis.The age,body mass index,pre-puncture PSA level and pathologic score were collected.The PSA level,biochemical recurrence time and so on were followed up for endocrine therapy.Results: There was no significant difference in age,body mass index,pre-puncture PSA level and puncture pathology score between the two groups.23 patients of CRP group with successful cytoreductive radical prostatectomy,the operation average time was 2.72±1.06 h,the average blood loss was 137.0 ± 199.6ml,the average time of posterior pubic drainage was 7.1 ± 2.2 d;the average time of urine drainage wsa 16.4 ± 4.9 Day;the average postoperative hospital time was 8.3 ± 2.7 d.1 patient got urinary tract infection,2 patients got anastomotic leakage,2 patients got delayed lymphatic leakage.There was no intraoperative blood transfusion,ureteral injury,rectal injury,incision infection or deep vein thrombosis of lower extremities.The were 6 cases confirmed as positive margin,the positive result was 26.09%.2 of the 23 cases in the CRP group got instant urinary control after the extraction of the urethral catheter.After postoperative sphincter exercise,a total of 17 cases(73.9%)got complete urinary control after 3months and 21 cases(91.3%)after 6 months.The two groups of patients were followed up for 3 to 37 months.There were 6 cases of CRP group progress to CRPC and 22 cases of endocrine group.The Kaplan-Meier curve was used to predict the median time to progress.The CRP group was 27 ± 2.80 months and the endocrine group was 18 ± 0.59 months.The log-rank test and Breslow test showed that the P value was less than 0.05,the difference was statistically significant.Conclusion: In the treatment of cytoreductive radical prostatectomy combined with endocrine treatment of oligotransferectomy prostate cancer,the incidence of complications is low,the severity is under control,postoperative urinary control recovery is good.In the absence of the current means of cure,the recent tumor control effect can be extended to patients without progression of survival time.Long-term efficacy such as overall survival,tumor specific survival rate to be further follow-up assessment.