To explore the feasibility and short-term clinical efficacy of robot-assisted laparoscopic radical prostatectomy (RARP) via transvesical approach for locally advanced prostate cancer after neoadjuvant hormone therapy.

The data of 75 patients with locally advanced prostate cancer who underwent transvesical approach RARP in the First Affiliated Hospital of Nanchang University from January 2021 to August 2023 were retrospectively analyzed. The PSA of the patients at initial diagnosis was 14.1-182.8 ng/ml, with an average of 52.5±23.9 ng/ml. After 3-6 months of neoadjuvant hormone therapy before surgery, the PSA decreased to 0.01-4.2 ng/ml, with an average of 0.6±0.2 ng/ml, and then transvesical approach RARP and extended pelvic lymph node dissection were performed. The perioperative data of the patients were recorded, and the postoperative PSA and urinary control of the patients were followed up.

Transvesical approach RARP and extended pelvic lymph node dissection were successfully completed in 75 patients, without conversion to open surgery. The operation time was 90-150 minutes, with a median operation time of 120 minutes; the intraoperative blood loss was 50-300 ml, with a median blood loss of 150 ml; the postoperative hospital stay was 3-7 days, with an average of 4.7±0.8 days; the postoperative drainage tube retention time was 3-6 days, with an average of 3.5±0.3 days, and the catheter retention time was 10-14 days. There were no intraoperative complications such as rectal injury and nerve injury. Postoperative pathology showed that 14 patients had positive resection margins, with a positive rate of 18.7%. The number of pelvic lymph nodes dissected was 12-25, with a median of 16, and 25 patients with positive lymph nodes. The follow-up time was 12-32 months, and PSA was rechecked 1-3 months after surgery, with a PSA of 0.001-0.05 ng/ml. The urinary control rates were 62.7%, 85.3%, 92% and 97.3% immediately after surgery, 3 months, 6 months and 12 months, respectively. Biochemical recurrence occurred in 4 cases, and no local recurrence or distant metastasis was observed in the other patients.

Preoperative neoadjuvant hormone therapy for locally advanced prostate cancer can help reduce tumor size and stage, and reduce the difficulty of surgery. Transvesical RARP for locally advanced prostate cancer is safe and feasible, with satisfactory tumor control and early urinary control recovery effects. Multicenter, large-sample studies are still needed to further verify this in the future.