手術前雄性素剝奪療法的根除性攝護腺切除術及短期腫瘤學結果

蔡祐婷、王弘仁、陳彥達、陳建旭、鄭元佐、羅浩倫

高雄長庚紀念醫院泌尿科

Preoperative androgen deprivation therapy for radical prostatectomy and short-term oncological outcomes

You-Ting Tsai, Hung-Jen Wang, Yen-Ta Chen, Chien-Hsu Chen, Yuan-Tso Cheng, Hau-Lun Luo

Department of Urology, Kaohsiung Chang Gung Memorial Hospital

Purpose: The efficacy of neoadjuvant hormone therapy in patients with clinically localized prostate cancer remains controversial. Previous study revealed neoadjuvant androgen deprivation therapy (ADT) may decrease the rate of positive resection margin. Therefore, the aim of this study is to evaluate the relationship between preoperative androgen deprivation therapy and postoperative positive surgical margin after radical prostatectomy.

Materials and Methods: In this single-center, retrospective study, we identified patients with clinically localized prostate cancer who had undergone radical prostatectomy (RP) at Kaohsiung Chang Gung Memorial Hospital between January 2021 and January 2024. Patients who had been treated with preoperative ADT or ADT plus androgen receptor-targeted agent were compared with those untreated. Preoperative clinicopathologic characteristics including PSA, Gleason score and clinical stage were assessed. Postoperative pathological results including surgical margin status were collected. Time to postoperative ADT or salvage radiation therapy (RT) was compared using the Kaplan-Meier method.  

Results: A total of 259 patients were enrolled: 159 to the RP only group, and 100 to the preoperative ADT group, respectively. The positive surgical margin rate was significantly lower in the preoperative ADT group than the RP only group (P <0.001). Lower PSA value during prostate cancer diagnosis resulted in significantly lower positive surgical margin rate (10.92 [IQR 7.16 to 17.88] vs. 16.87 [IQR 10.57 to 29.48]; P<0.001). Furthermore, lower PSA value after preoperative ADT led to significantly lower positive surgical margin rate (0.44 [IQR 0.09 to 2.82] vs.12.58 [IQR 0.99 to 24.09; P<0.001]). No significant differences were noted in salvage-RT free survival and postoperative ADT-free survival between the RP only group and the preoperative ADT group.

Conclusion: Preoperative ADT significantly decreased the incidence of positive surgical margin. Moreover, lower PSA value after preoperative ADT resulted in significantly lower positive surgical margin rate.