| Research backgroundProstate cancer is one of the most common malignant tumors in the world.Although the incidence of prostate cancer is relatively low in China,it is increasing year by year.And the domestic discoverers are both late and high in stages.Prostate specific antigen combined with rectal examination is the best way to screen for early prostate cancer.Prostate’s MRI,CT and bone scan may appear prostate capsule,tumor infiltration,the complement of local invasion and lymph node metastasis,the diagnosis of prostate cancer remains to be line of prostate biopsy,partly by cutting prostate tissue examination revealed.Through digital rectal organs,transrectal gray-scale ultrasound,pelvic MRI,GanDanYi spleen ultrasound and whole body bone imaging to determine the clinical staging of prostate cancer.The risk was assessed according to Gleason score,PSA level and clinical stage.Early localized prostate cancer undergoing radical prostatectomy or radical radiation therapy has good effect,but locally advanced or distant metastasis need to take comprehensive treatment,including neoadjuvant endocrine combined with radical prostatectomy,and postoperative adjuvant endocrine therapy with radiotherapy.Explore the new adjuvant endocrine therapy of radical resection of the prostate cancer pathology and the influence of operation parameters,choice of neoadjuvant endocrine and duration,and determine the curative effect and evaluating prognosis will have important significance.ObjectiveTo explore neoadjuvant endocrine therapy patients underwent radical prostat ectomy for prostate cancer pathology Gleason grading change and the influence of the parameters related to the operation effect,for clinical reasonable select new adjuvant endocrine therapy time provide foundation for better diagnosis and treatment and preoperative instruction basis.MethodThrough a retrospective analysis of 428 patients with radical prostatectomy in the first affiliated hospital of zhengzhou university from January 2012 to September 2017,there were 342 patients with complete data.According to different treatment divided into the following four groups,the RP group: by transrectal prostate biopsy or transurethral resection of prostate after cutting specific diagnosis of prostate cancer,in pure line 1 to 4 weeks to radical prostatectomy,NHT1 group: 1 month in application of androgen deprivation therapy before radical prostatectomy,NHT2 groups: 2 months in application of androgen deprivation therapy before radical prostatectomy,NHT3 groups: three to nine months treatment of androgen deprivation before radical prostatectomy,contrast analysis between groups of patients with postoperative Gleason score changes and the clinical stage,PSA,baseline preoperative Gleason scores and risk of prostate cancer,etc.And statistying by A single line of leonardo Da Vinci robots on the surgery patients with radical prostatectomy,straight into the group of 133 cases,divided into four groups based on the preoperative neoadjuvant therapy time,by transrectal prostate biopsy after definite diagnosis,1-4 weeks in direct line of radical prostatectomy for control group,the radical prostatectomy preoperative use of androgen deprivation therapy duration 0 month,1 month,2 months,and 3 ~ 9 months are all included in the control way,group A and group B and group C,each group has 29,47,30,27 cases.Comparative analysis between groups in patients with PSA decline degree,degree of prostate volume reduced,operation time,intraoperative blood loss,cutting edge positive situation,seminal vesicle invasion,lymph node positive rate and bladder neck and involvement and nerve invasion rate.All data were analyzed by using SPSS 22.0 software,and the statistical methods such as row * rikka square test and mann-whitney rank and test are used.ResultsAnalyzed by studying the data of 342 patients who underwent radical resection of the prostate cancer found that compared with the preoperative 1 month,2 months or no preoperative neoadjuvant therapy,preoperative more than 3 months of neoadjuvant therapy can obviously improve the Gleason score(compared with the RP group Z value to 3.390,p < 0.01),and preoperative neoadjuvant therapy of January or February doesn’t can improve postoperative Gleason score(compared with the RP group,Z value respectively 0.972,1.424,p > 0.05).Preoperative initial PSA and no obvious correlation between the improvement,and clinical staging < stage T2 b,preoperative Gleason score 7 points or less,and no risk of localized prostate cancer patients using three months above neoadjuvant therapy can effectively improve postoperative Gleason scores,for clinical staging ≧ T2 b period,preoperative Gleason score eight points and local progression or metastasis or prostate cancer patients using any time new adjuvant endocrine therapy does not improve postoperative Gleason score.And further analyzes the hospital by xue-pei zhang,A professor at the same time preoperative simply by transrectal prostate biopsy of the prostate cancer diagnosis 133 Da Vinci robot assisted radical prostatectomy cases related to the operation data,found that in the control group patients before puncture for PSA is 0.2 ~ 97.6 ng/ml,an average of 19.05 ng/ml.The group A patients before piercing is PSA1.3 ~ 157 ng/ml,58.59 ng/ml,after neoadjuvant endocrine therapy in January the PSA is 0.01 ~ 15.8 ng/ml,3.13 ng/ml.The group B patients before piercing PSA is 4.5 ~ 494 ng/ml,73.75 ng/ml,PSA after neoadjuvant endocrine therapy in February fell to 0.05 ~ 18.39 ng/ml,an average of 2.96 ng/ml.The C groups of patients before piercing PSA is 3.06 ~ 454 ng/ml,120.28 ng/ml,by September 3-PSA after neoadjuvant endocrine therapy reduced to 0.02 ~ 55.36 ng/ml,1.57 ng/ml.Control group of patients with prostate biopsy before the volume of 12.67 ~ 138.44 ml,an average of 45.17 ml.A group of patients before piercing prostate volume 12.67 ~ 138.44 ml,an average of 45.17 ml after neoadjuvant endocrine therapy in January the prostate volume of 9.1 ~ 76.05 ml,an average of 33.06 ml.Group B patients puncture before the volume of 20.36 ~ 103.03 ml,an average of 45.00 ml,prostate volume after neoadjuvant endocrine therapy in February 10.55 ~ 62.40 ml,an average of 28.49 ml.C groups of patients before piercing volume of 14.72 ~ 170.68 ml,an average of 37.35 ml,by September 3-after neoadjuvant endocrine therapy of prostate volume of 15.6 ~ 51.48 ml,an average of 27.23 ml.The operation time in control group is 65 ~ 210 min,an average of 137.64 min.Group A 55~329min,average 142.49 min.Group B 68~300min,average 141.60min: group C 64~247min,average 141.55 min.Intraoperative bleeding control group 50.0~500.0ml,average 170.89 ml,no intraoperative blood transfusion;A group of 20.0~1500.0ml,with an average of 166.52 ml,one patient had 800 ml blood transfusion.Intraoperative hemorrhage B group was 20 ~ 600 ml,with an average of 153.67 ml and no intraoperative blood transfusion.Group C 20 ~ 500 ml,average hemorrhage 141.55 ml,no intraoperative blood transfusion.There were 6 cases of positive prostate incisions in the control group after surgery,7 cases of seminal vesicle adenoids,2 cases of bladder neck invasion,6 cases of local lymphoblastic and 4 cases of neuroinvasion.In group A,there were 12 cases of positive prostate cutting edge,14 cases of seminal vesicle invasion,3 cases of bladder neck invasion,11 cases of local lymphoblastic and 9 cases of neuroinvasion.In group B,there were 7 cases of positive prostate incisions,7 cases of seminal vesicle invasion,3 cases of bladder neck invasion,6 cases of local lymphoblastic and 6 cases of neuroinvasion.In group C,3 cases were found to be positive in the prostatic cutting edge,5 cases of seminal vesicle adenoids,1 case of bladder neck mouth invasion,3 cases of local lymph node positive and 3 cases of neuroinvasion.ConclusionsThe new adjuvant therapy for three to nine months can effectively improve the postoperative pathologic Gleason score in patients with localized prostate cancer,and some patients can obtain pathological treatment.In three to nine months,androgen block therapy can significantly reduce prostate tumor volume and PSA,and theoretically reduce the chance of surgery for patients with advanced local terminal diseases through clinical depression.The treatment of androgen blockade in 3 months do not significantly increase the difficulty of surgery and complications.Neoadjuvant androgen depriation therapy in combination with radical prostatectomy,the high-risk patients with locally advanced and surgery opportunity,can be obtained in low risk patients can get the improvement of the postoperative pathological Gleason score,new treatment methods for patients with prostate cancer.But it still has potential tumor recurrence and metastasis,compared with the traditional adjuvant endocrine therapy or radiotherapy alone,whether can improve the long-term prognosis of patients with prostate cancer,remains to be further long-term follow-up results of observation,considering the existence possibility castration resistance to endocrine therapy,a more appropriate time neoadjuvant endocrine therapy effect needs further research. |
