Retzius 保留達文西攝護腺根除手術+/-術前賀爾蒙Degarelix注射

對第四期或非常高復發風險攝護腺癌的初步結果

林威宇¹²³

 ¹嘉義長庚醫院泌尿科，²長庚大學醫醫學院，³成功大學醫醫學院

Retzius Sparing Robot- Assisted Radical Prostatectomy with/without Neoadjuvant Degarelix for stage IVA or Very High Risk Prostate Cancer-Preliminary Results       

Wei-Yu Lin¹²³

1Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

2Medical College, Chang Gung University, Taiwan

3Medical College, National Cheng Kung University, Taiwan

Purpose: Data about retzius sparing robotic assissted radical prostatectomy (RS-RARP) for clinical N1 prostate cancer (Stage IVA PCa) or Very high risk PCa (VHRPCa) is lacking. Also, Data about neoadjuvat degarilix (NeoDeg) for Stage IVA PCa or VHRPCa is sparse. The aim of this study is to evaluate the oncological and functional outcomes of RS-RARP with or without NeoDeg for patients with Stage IVA PCa or VHRPCa.

terials and Methods : 58 patients with stage IVAPCa or VHRPCa who underwent RS-RARP between 2018 and 2024 with NeoDeg (N=24) and without NeoDeg (N=34) were retrospectively evaluated. Perioperative functional, and oncological outcomes were compared between groups.

Results: Perioperative outcomes including operative time, estimated blood loss, days for hospital stay and days for catheter removal were comparable. Overall, 32(55%), 36 (58%), 22 (38%) ，19(33%) and 14(24%)　patients had pT3b, cN1or pN1, positive surgical margins (PSM), detectable PSA postoperatively, and 12-month biochemical recurrent rate. Compared to RS-RARP group, NeoDeg group revealed lower PSM, detectable PSA postoperatively, lower 12-month biochemical recurrent rate, and notable pathological downstaging. Overall, 12-month continence rate was all 80% in both groups. The median number of nodes removed in ePLND was 18.  Overall, 4(7%) patients experienced Clavien III complications. 　

Conclusions: RS- RALP with or without NeoDeg is a feasible option for patient with stageIVAPCa or VHPCa . Neodeg provides better perioperative oncological outcomes. The improved oncological outcomes could be owing to its potential curative role and the correct staging for subsequent multimodal treatments.