Clinical Analysis of Perioperative Outcomes on Neoadjuvant Hormone Therapy before Laparoscopic and Robot-Assisted Surgery for Localized High-Risk Prostate Cancer in a Chinese Cohort

Abstract

Objective: To analyze the perioperative outcomes of neoadjuvant hormone therapy (NHT) before laparoscopic and robot-assisted surgery for localized high-risk prostate cancer in a Chinese cohort. Methods: The clinical data of 385 patients with localized high-risk prostate cancer who underwent radical prostatectomy (RP) in our hospital from January 2019 to June 2021 were analyzed retrospectively, including 168 patients with preoperative NHT and 217 patients with simple surgery. Clinical characteristics were compared in the above two groups, the laparoscopic RP (LRP) cohort (n = 234) and the robot-assisted laparoscopic radical prostatectomy (RALP) cohort (n = 151), respectively. Results: In the overall cohort, compared with the control group, the NHT group had a shorter operative time, less blood loss, a lower positive surgical margin rate, and a higher proportion of Gleason score (GS) downgrading after the operation (p < 0.05). However, there was no significant difference in hospitalization time, biochemical recurrence, urine leakage, urinary continence, or prostate-specific antigen (PSA) progression-free survival (p > 0.05). In the LRP cohort, it was found that the NHT group also had shorter operative time, less blood loss, lower positive surgical margin rate, a higher proportion of GS downgrading after the operation, and faster recovery of urinary control than the control group (p < 0.05). There was no marked difference in hospitalization time, biochemical recurrence, urinary leakage, or PSA progression-free survival. However, in the RALP cohort, the NHT group had a significant difference in the GS downgrading after the operation compared with the control group (p < 0.05). In the overall cohort, multiple analyses showed that initial PSA level, GS at biopsy, clinical T stage, lymph node invasion, use of NHT, and surgical methods were significantly associated with positive surgical margin (p < 0.05) while NHT did not account for biochemical recurrence (p > 0.05). Conclusions: NHT can lower the difficulty of surgery, reduce positive surgical margin rate, and help recovery in short-term urinary control in patients with high-risk prostate cancer after LRP. However, we do not have evidence on the benefit of NHT in high-risk PCa patients treated with RALP. For these patients, surgery can be performed as early as possible.

Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy

“…The main finding of our study is that the NHT patients did not experience major complications or readmissions after RARP. Our findings are in line with Naiki et al, who found in their laparoscopic prostatectomy series that the perioperative morbidity of NHT patients was equivalent to that of non-NHT patients [6]. On the contrary, radiotherapists reported hormonal therapy to be associated with higher comorbidities, especially in patients with cardiovascular risk factors [4,5].…”

“…Nevertheless, they were higher in NHT patients (21.8% compared to 5.4% in the NNHT group). This is in contrast to others who noted lower positive surgical margins and a lower PSA recurrence rate in NHT patients [6]. This might be somewhat explained by the trial of nerve-sparing in sexually motivated men harvesting aggressive tumors.…”

“…Its use has also been studied in combination with cryotherapy [5]. Some authors found NHT to facilitate laparoscopic radical prostatectomy (LRP) and RARP, reduce the positive surgical margin rate, and accelerate the recovery of short-term urinary control [6]. A prolonged NHT of 8 months was found to have no additional benefits compared to the 3-month period of NHT in a laparoscopic radical prostatectomy cohort, and both regimes were found to lower positive surgical margin rates compared to patients who underwent surgery without previous therapy [7].…”

Efficacy and Safety of Neoadjuvant Luteinizing Hormone-Releasing Hormone Antagonist and Tegafur-Uracil Chemohormonal Therapy for High-Risk Prostate Cancer

“…Although several guidelines recommend that surgery be part of a comprehensive treatment for high-risk PCa [ 2 , 4 ], pathological findings suggest that a relatively high proportion of PSM may not be cured by RP and consequently require adjuvant therapy [ 38 ]. Therefore, neoadjuvant therapy is administered to improve surgical and oncologic outcomes in patients with high-risk PCa [ 15 , 16 , 40 , 41 , 42 ]. NHT prior to RP has been tried in combination with cytotoxic agents as it was found to increase the negative surgical margin rate but not prevent BCR [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

Treatment Strategies for High-Risk Prostate Cancer - Utility of Combination Therapy of Neoadjuvant Therapy and Radical Prostatectomy to Improve Oncologic Outcomes

“…Similarly, three cohort studies showed that NHT prior to RP failed to lead to a significant BRFS advantage compared to RP alone (pooled HR, 1.00; 95% CI, 0.78-1.54) [41]. Sun et al [42] retrospectively analyzed clinical data from 385 patients with high-risk PCa who underwent RP, including 168 patients who underwent neoadjuvant NHT followed by RP and 217 patients who underwent RP alone. Although patients who received neoadjuvant ADT had shorter operative times, decreased volume of blood loss, lower rates of PSM, and higher rates of downstaging GG after RP (p<0.05), there were no statistically significant improvements in BCR, BRFS, or perioperative complications [42].…”