Vaidya A, Soloway M S
Department of Urology, University of Miami, Miami, Florida, USA.
J Urol. 2000 Dec;164(6):1998-2001.
With the advent of prostate specific antigen (PSA) testing and transrectal ultrasound guided prostate biopsy there has been stage migration in the diagnosis of prostate cancer, so that more younger men are being diagnosed with organ confined prostate cancer. Many patients elect radiation therapy, while some have recurrent or new prostate cancer with absent systemic disease and life expectancy greater than 10 years. We present our experience with salvage radical prostatectomy in these cases.
Between 1995 and 2000, 6 men treated with curative intent with radiotherapy for prostate cancer were subsequently treated with salvage surgery for clinically localized prostate cancer. All men had biopsy proved recurrent or persistent prostate cancer, increasing serum PSA, no evidence of systemic disease at surgery and life expectancy greater than 10 years. We assessed the morbidity associated with this procedure and compared results to those in the contemporary literature.
Six patients underwent salvage radical prostatectomy. Initial pre-radiation PSA was 4.5 to 15.7 ng./ml. Pre-radiation disease was clinical stage T1c in 5 cases and B2 in 1. The interval from radiotherapy to repeat biopsy was 12 to 48 months. A mean of 6.3 months after local recurrence was detected and before salvage radical prostatectomy was performed 4 patients underwent androgen deprivation therapy. Mean operative time was 195 minutes, intraoperative blood loss was 680 cc, and hospital stay and catheterization time were 3.2 and 13.8 days, respectively. There were no rectal injuries. All 6 patients are impotent, 5 are continent and 1 has mild stress incontinence. There was biochemical failure in 1 case 36 months after salvage radical prostatectomy and no evidence of recurrence in the remaining 5 at a mean followup of 27 months.
Salvage radical prostatectomy is a technically challenging procedure. In the past it was associated with a high incidence of rectal injury, urinary incontinence and anastomotic stricture. The results of our relatively small series are encouraging and concur with those of recent studies that the morbidity of salvage radical prostatectomy is lower than previously reported. We believe that salvage radical prostatectomy may be considered a reasonable treatment option in appropriate patients with radiorecurrent prostate cancer.
随着前列腺特异性抗原（PSA）检测和经直肠超声引导下前列腺穿刺活检技术的出现，前列腺癌的诊断出现了分期上移，因此有更多的年轻男性被诊断为局限性前列腺癌。许多患者选择放射治疗，而一些患者在无全身疾病且预期寿命超过10年的情况下出现复发性或新发前列腺癌。我们在此介绍我们在这些病例中进行挽救性根治性前列腺切除术的经验。
1995年至2000年间，6名接受前列腺癌根治性放疗的男性随后接受了挽救性手术治疗临床局限性前列腺癌。所有男性均经活检证实为复发性或持续性前列腺癌，血清PSA升高，手术时无全身疾病证据且预期寿命超过10年。我们评估了该手术相关的并发症，并将结果与当代文献中的结果进行了比较。
6例患者接受了挽救性根治性前列腺切除术。放疗前初始PSA为4.5至15.7 ng/ml。放疗前疾病临床分期T1c为5例，B2为1例。从放疗到重复活检的间隔时间为12至48个月。在检测到局部复发后平均6.3个月，在进行挽救性根治性前列腺切除术之前，4例患者接受了雄激素剥夺治疗。平均手术时间为195分钟，术中失血680 cc，住院时间和导尿时间分别为3.2天和13.8天。无直肠损伤。6例患者均阳痿，5例控尿，1例有轻度压力性尿失禁。1例患者在挽救性根治性前列腺切除术后36个月出现生化复发，其余5例在平均随访27个月时无复发证据。
挽救性根治性前列腺切除术是一项技术上具有挑战性的手术。过去，它与直肠损伤、尿失禁和吻合口狭窄的高发生率相关。我们相对较小系列的结果令人鼓舞，与近期研究结果一致，即挽救性根治性前列腺切除术的并发症发生率低于先前报道。我们认为，对于合适的放射性复发前列腺癌患者，挽救性根治性前列腺切除术可被视为一种合理的治疗选择。
