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Cytoreductive radical prostatectomy after chemohormonal therapy in patients with primary metastatic prostate cancer

Asian Journal of Urology 2022年第1期9卷 69-74页

作者： Christa Babst Thomas Amiel Tobias Maurer Sophie Knipper Lukas Lunger Robert Tauber margitta retz Kathleen Herkommer Matthias Eiber Gunhild von Amsbergb Markus Graefen Juergen Gschwend Thomas Steuber Matthias Heck Department of Urology Technical University of MunichRechts der Isar Medical CenterMunichGermany Martini-Klinik Prostate Cancer Center HamburgGermany

Objective:Cytoreductive radical prostatectomy(cRP)has been proposed as local treatment option in metastatic hormone-sensitive prostate cancer(mHSPC)to prevent local complications and potentially improve oncological *** this study,we examined the feasibility of a multimodal concept with primary chemohormonal therapy followed by cRP and analyzed prostate size reduction under systemic treatment,postoperative complication rates,as well as early postoperative ***:In this retrospective study,38 patients with mHSPC underwent cRP after primary chemohormonal therapy(3-monthly luteinising hormone-releasing hormone-analogue+six cycles 3-weekly docetaxel 75 mg/m2)at two centers between September 2015 and December ***:Overall,10(26%)patients had high volume and 28(74%)patients had low volume disease at diagnosis,according to CHAARTED *** prostate-specific antigen(PSA)decreased from 65 ng/mL(interquartile range[IQR]35.0-124.5 ng/mL)pre-chemotherapy to 1 ng/mL(IQR 0.3-1.7 ng/mL)*** gland volume was significantly reduced by a median of 50%(IQR 29%-56%)under chemohormonal therapy(p=0.003).Postoperative histopathology showed seminal vesicle invasion in 33(87%)patients and negative surgical margins in 17(45%)*** complications(Grade 3 according to Clavien-Dindo)were observed in 4(11%)patients within 30 *** was reached in 87%of patients after 1 month and in 92%of patients after 6 *** time to castration-resistance from begin of chemohormonal therapy was 41.1 months and from cRP was 35.9 *** PSA-nadir≤1 ng/mL versus>1 ng/mL was a significant predictor of time to castration-resistance after cRP(median not reached versus 5.3 months;p<0.0001).Conclusion:We observed a reduction of prostate volume under chemohormonal therapy going along with a low postoperative complication and high early continence ***,the oncologic benefit from cRP is still under evaluation.

关键词： Metastatic hormone-sensitive prostate cancer Chemohormonal therapy Cytoreductive radical prostatectomy Feasibility Prevent local complications Continence rate

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