Observation of the positive surgical margins after radical resection of pT3 prostate cancer using on-demand intermittent total androgen blockade therapy
10.12483/j.issn.1009-8291.2026.01.005
- VernacularTitle:按需间歇全雄激素阻断治疗pT3期前列腺癌根治术后切缘阳性病例观察
- Author:
Hui GUO
1
;
Rong CHEN
1
;
Xinru ZHANG
1
Author Information
1. Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200233, China
- Publication Type:Journal Article
- Keywords:
prostate cancer;
radical prostatectomy;
positive surgical margin;
androgen deprivation therapy;
endocrine therapy;
prostate-specific antigen;
radiotherapy
- From:
Journal of Modern Urology
2026;31(1):21-25
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the efficacy of the on-demand intermittent total androgen blockade regimen in treating cases with positive surgical margins after radical prostatectomy for pT3 stage prostate cancer. Methods A retrospective analysis was conducted on the clinical data of 21 patients with pT3 stage prostate cancer who underwent radical prostatectomy and had positive surgical margins confirmed by pathology in our hospital during Jan. 2013 and Dec. 2020. Prostate-specific antigen(PSA)was used as the indicator of observation. For those with biochemical recurrence(PSA＞0.2 μg/L), at least 2 months of androgen deprivation therapy(ADT)combined with the maximum androgen receptor antagonist was administered for maximal androgen blockade endocrine therapy. If PSA still exceeded 0.1 μg/L after 2 months of maximal androgen blockade treatment, the maximal androgen blockade was maintained and monthly follow-up was conducted until PSA reached the discontinuation criteria. During the discontinuation period, the serum PSA and testosterone levels were checked every 4 to 6 weeks. The time of application of maximal androgen blockade and the subsequent interval of discontinuation were defined as one treatment cycle. Results Postoperative pathology confirmed that among the 21 patients, 17 were pT3a and 4 were pT3b. The PSA level 1 month after surgery was(0.23±0.45)μg/L. The follow-up lasted for 48 to 126 months, with an average of(68.86 ± 20.43)months. The interval between the first application of maximal androgen blockade and radical prostatectomy was 2 to 35 months, with an average of(12.48±8.83)months. One patient died of post-cerebral infarction complications 74 months after surgery, another progressed to hormone-resistant prostate cancer(CRPC)70 months after surgery and the treatment plan was immediately changed. Up to 90.5%(19/21)of the patients completed 5 to 12 cycles of combined endocrine therapy, with no tumor progression. Conclusion Based on the postoperative PSA level monitored, intermittent administration of the maximum androgen blockade endocrine therapy can effectively control the cancer progression of patients with positive surgical margins after radical prostatectomy, which can also reduce the adverse reactions.
