根治性攝護腺切除術前新輔助雄激素剝奪療法的早期腫瘤學結果-單一中心經驗與文獻回顧

謝佳駤¹、曾文歆^1,2、劉建良^1,3、黃冠華¹、邱文祥⁴

¹台南永康奇美醫院 外科部 泌尿科；²國立中山大學生物醫學研究所；³台南永康奇美醫院 外科部 泌尿腫瘤科；⁴台北新光吳火獅紀念醫院 泌尿科

The Early Oncological Outcome of Neoadjuvant Androgen Deprivation Therapy Before Radical Prostatectomy – A Single-center Experience and Literature Review

Chia-Chih Hsieh¹、Wen-Hsin Tseng^1,2、Chien-Liang Liu ^1,3、Steven K. Huang¹、Allen W.Chiu⁴

¹Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

²Institute of Biomedical Science, National Sun Yat-Sen University, Kaohsiung, Taiwan;

³Division of Uro-Oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan;

⁴Department of Urology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.

Purpose:

Neoadjuvant systemic therapy is a standard of care for several solid tumor malignancies. It has been evaluated prior to radical prostatectomy in recent studies but no consensus yet. This study investigates the early oncological outcomes of high- and very-high-risk prostate adenocarcinoma receiving radical prostatectomy (RP) with neoadjuvant androgen deprivation therapy (ADT).

Materials and Methods:

This study included 59 patients diagnosed with high- or very-high-risk prostate adenocarcinoma who underwent robotic-assisted RP with pelvic lymph node dissection from January 2017 to December 2022. Follow up until March 2024, and grouped as disease-free group and non-disease-free group according to post-operative PSA level. The study analyzed baseline characteristics, comorbidities, and outcomes, comparing approaches using chi-squared and Student’s t-tests.

Results:

In this study, a total of 59 patients received neoadjuvant-ADT and 9 patients were excluded due to loss follow-up or insufficient data. During follow up period, 28 patients who remained undetectable PSA level were grouped as disease-free and 22 patients suffered from PSA persistence/recurrence were grouped as non-disease-free group. On comparing the patient characteristic between two groups, we found that the biopsy Gleason score (GS) showed significantly lower in disease-free group (primary GS, p=0.001; total GS, p=0,003). MRI clinical stage also down-staging to lower stage in disease-free group but no significant difference was found (p=0.111). Pathological stage had significantly lower stage in disease-free group (p=0.023) and surgical-margin-free rate was significantly higher in disease-free group (p=0.035). Pathological total GS was also significantly lower in disease-free group (p=0.048). However, lower residual tumor volume percentage may associate with disease-free but no significantly difference between two groups was found (p=0.10).

Conclusion:

This study supports disease-free group was associated with lower biopsy GS, lower pathological GS, lower pathological stage and higher margin-free rate. These factors may consider as predictors for disease-free rate among the patients receiving neo-adjuvant ADT before RP.