Objective

To determine the feasibility and outcome of radical prostatectomy (RP) following neoadjuvant therapy (NAT) in patients with initial inoperable, rectum-infiltrating cT4 prostate cancer (PCa).

Methods

From 01/2018 to 12/2020, 26 patients with clinical (DRE) or radiographical (mpMRI) suspicion of rectum infiltrating PCa at diagnosis and NAT prior to RP were retrospectively identified from our prospective institutional database. Two patients were still inoperable after NAT. Downsizing was administered for at least 20 weeks and RP was performed after excluding ongoing rectal infiltration.

Results

At diagnosis, median PSA was 42.5 ng/ml (IQR: 23.0–66.1). Inductive NAT consisted of androgen deprivation therapy (ADT) in combination with chemotherapy (n = 9) or without chemotherapy (n = 14). Median preoperative PSA was 0.93 ng/ml (IQR: 0.24–0.40). Median time from NAT to RP was 6 months (IQR: 5–7). Two patients were still inoperable after NAT. Of 24 patients undergoing RP, abortion of surgery due to inoperability was observed in 2 patients (8.4%), demonstrating a total failure rate of NAT in 4 out of 26 patients (15.4%). One patient suffered a rectal injury with consecutive colostomy (4.2%). No Clavien-Dindo complication Grade IV or V were observed. Urinary continence was achieved in 16 patients (84.2%). Sufficient erection for sexual intercourse was present in 2 patients (10.5%). All patients received adjuvant ADT with or without radiation therapy. Median PSA at 13 months was 0.08 ng/ml (IQR: 0.01–0.74).

Conclusion

RP of initially rectum infiltrating PCa is feasible and safe after inductive NAT, however complications rates tend to be higher compared to standard RP.

中文翻译：

---

疑似直肠浸润患者在诱导新辅助治疗后行根治性前列腺切除术的可行性和结果

客观的

确定初始无法手术的直肠浸润性 cT4 前列腺癌 (PCa) 患者新辅助治疗 (NAT) 后根治性前列腺切除术 (RP) 的可行性和结果。

方法

从 2018 年 1 月 1 日到 2020 年 12 月，从我们的前瞻性机构数据库中回顾性地确定了 26 名临床 (DRE) 或影像学 (mpMRI) 在诊断和 RP 前 NAT 时怀疑直肠浸润 PCa 的患者。两名患者在 NAT 后仍然无法手术。缩小尺寸至少持续 20 周，并在排除正在进行的直肠浸润后进行 RP。

结果

诊断时，中位 PSA 为 42.5 ng/ml (IQR: 23.0–66.1)。诱导 NAT 包括雄激素剥夺疗法 (ADT) 与化疗 ( n  = 9) 或不与化疗 ( n = 14)。术前 PSA 中位数为 0.93 ng/ml（IQR：0.24-0.40）。从 NAT 到 RP 的中位时间为 6 个月（IQR：5-7）。两名患者在 NAT 后仍然无法手术。在接受 RP 的 24 名患者中，有 2 名患者（8.4%）因无法手术而流产，表明 26 名患者中有 4 名（15.4%）的 NAT 总失败率。一名患者因连续结肠造口术而遭受直肠损伤（4.2%）。未观察到 Clavien-Dindo 并发症 IV 级或 V 级。16 名患者（84.2%）实现了排尿节制。2 名患者（10.5%）存在足够的性交勃起。所有患者都接受了辅助 ADT，有或没有放射治疗。13 个月时的中位 PSA 为 0.08 ng/ml (IQR: 0.01–0.74)。

结论

初始直肠浸润 PCa 的 RP 在诱导 NAT 后是可行且安全的，但与标准 RP 相比，并发症发生率往往更高。