Progress of neoadjuvant therapy for high-risk prostate cancer in the era of novel hormonal therapy / 现代泌尿外科杂志

In the past, the use of neoadjuvant androgen deprivation therapy (ADT) for prostate cancer did not exhibit survival benefits and was not recommended by the practicing guidelines. In recent years, with the emergence of novel hormonal therapeutics such as Abiraterone, Enzalutamide, Apalutamide and Darolutamide, the interest for neoadjuvant therapy has been reignited. Here, we summarize the four categories of neoadjuvant therapy with new hormonal agents, and discuss how to evaluate the efficacy and explore the molecular mechanism after neoadjuvant therapy.

Neoadjuvant radiohormonal therapy for oligo-metastatic prostate cancer: safety and efficacy outcomes from an open-label, dose-escalation, single-center, phase I/II clinical trial / 医学前沿

To evaluate the safety and efficacy of neoadjuvant radiohormonal therapy for oligometastatic prostate cancer (OMPC), we conducted a 3 + 3 dose escalation, prospective, phase I/II, single-arm clinical trial (CHiCTR1900025743), in which long-term neoadjuvant androgen deprivation was adopted 1 month before radiotherapy, comprising intensity modulated radiotherapy to the pelvis, and stereotactic body radiation therapy to all extra-pelvic bone metastases for 4-7 weeks, at 39.6, 45, 50.4, and 54 Gy. Robotic-assisted radical prostatectomy was performed after 5-14 weeks. The primary outcome was treatment-related toxicities and adverse events; secondary outcomes were radiological treatment response, positive surgical margin (pSM), postoperative prostate-specific antigen (PSA), pathological down-grading and tumor regression grade, and survival parameters. Twelve patients were recruited from March 2019 to February 2020, aging 66.2 years in average (range, 52-80). Median baseline PSA was 62.0 ng/mL. All underwent RARP successfully without open conversions. Ten patients recorded pathological tumor down-staging (83.3%), and 5 (41.7%) with cN1 recorded negative regional lymph nodes on final pathology. 66.7% (8/12) recorded tumor regression grading (TRG) -I and 25% (3/12) recorded TRG-II. Median follow-up was 16.5 months. Mean radiological progression-free survival (RPFS) was 21.3 months, with 2-year RPFS of 83.3%. In all, neoadjuvant radiohormonal therapy is well tolerated for oligometastatic prostate cancer.

Single-port robot-assisted laparoscopic radical prostatectomy through different approaches: initial experience and outcomes / 中华泌尿外科杂志

Objective:To evaluate the feasibility and effectiveness of sing-port robot-assisted laparoscopic radical prostatectomy(sp-RALP) through different approaches.Methods:The data of 115 patients who underwent sp-RALP through different approaches from May 2018 to June 2020 were retrospectively reviewed. In our study, 92 cases through extraperitoneal approach, 10 through transperineal approach and 13 though transvesical approach. Preoperative, intraoperative and early postoperative outcomes after various approaches were collected and analyzed. The mean age was 67(52-84) years, mean preoperative body mass index was 24.44(19.52-32.33) kg/m 2. Patients were graded as cT 1-3aN 0M 0 with no signs of regional lymph node invasion or distal metastasis. The median preoperative PSA was 9.77(6.54, 15.32) ng/ml. Results:All 115 sp-RALP were successfully completed with no conversion to open surgery or additional ports being placed. The mean operative time was 91.8(40-200)min, with 88.0(40-200)min for extraperitoneal approach, 132.5 (90-190)min for transperineal approach and 87.3(60-150)min for transvesical approach. The mean estimated blood loss was 85.5 (45-400)ml, with 77.6(50-200)ml for extraperitoneal approach, 178.0(80-400)ml for transperineal approach and 70.4 (45-150)ml for transvesical approach. Of the 115 patients, 60.9% (70/115)were <pT 3a, 39.1%(45/115) were ≥pT 3a. Positive margin(PSM) rate was 17.4%(20/115), with 31.1%(14/45) for ≥T 3a group, 8.6%(6/70) for <T 3a group. Postoperative pathology revealed a Gleason score of 3 + 3 in 6 patients, 3 + 4 in 45 patients, 4+ 3 in 52 patients, and ≥8 in 2 patients. Mean hospital stay was 3(1-7)d. Median postoperative PSA was 0.03(0.01, 0.05)ng/ml at 1 month postoperatively, and 88.7% patients reported less than 1 pad per day at 3 month postoperatively. Conclusions:With several advantages, such as better cosmesis, postoperative fewer pain, and better recovery as well as comparable oncological outcomes in the short-term follow-up, sp-RALP through various approaches is a feasible and effective procedure for organ-confined prostate cancer.