Van Der Poel H G, Moonen L, Horenblas S
Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
J Surg Oncol. 2008 Apr 1;97(5):377-82. doi: 10.1002/jso.20967.
To compare toxicity and efficacy of both salvage prostatectomy and salvage radiotherapy for prostate cancer a retrospective analysis was conducted. Thirty-two and 41 patients were treated with external beam radiotherapy or prostatectomy for cT1c-T2 prostate cancer later requiring salvage surgery or radiotherapy. Salvage surgery was performed when a local recurrence was biopsy confirmed and life-expectancy was more than 10 years. Salvage external beam radiotherapy was performed when PSA rose over 0.1 ng/ml in the absence of systemic disease. Ten-year PSA-recurrence free survival after primary treatment in the salvage surgery group and salvage radiotherapy groups was 55% and 44% (P > 0.05) respectively whereas prostate cancer specific survival was 93% and 89%, respectively (P > 0.05). Both, biopsy Gleason score prior to primary treatment and PSADT prior to salvage treatment were predictive of PSA-recurrence free survival. Patients after salvage radiotherapy (13%) were less likely to wear pads for urinary incontinence compared to patients after salvage surgery (56%). Erectile dysfunction was more frequent after salvage surgery (81%) compared to salvage radiotherapy (61%). Salvage surgery and salvage prostatectomy after primary cT1-2 prostate cancer provide comparable PSA-recurrence free survival after primary treatment. Genitourinary functions were better preserved in the salvage radiotherapy group compared to the salvage prostatectomy group.
为比较挽救性前列腺切除术和挽救性放射治疗对前列腺癌的毒性和疗效，进行了一项回顾性分析。32例和41例cT1c-T2期前列腺癌患者分别接受了外照射放疗或前列腺切除术，之后需要进行挽救性手术或放疗。当活检证实局部复发且预期寿命超过10年时，进行挽救性手术。当PSA在无全身疾病的情况下升至0.1 ng/ml以上时，进行挽救性外照射放疗。挽救性手术组和挽救性放疗组在初次治疗后的10年无PSA复发生存率分别为55%和44%（P>0.05），而前列腺癌特异性生存率分别为93%和89%（P>0.05）。初次治疗前的活检Gleason评分和挽救性治疗前的PSADT均为无PSA复发生存的预测因素。与挽救性手术后的患者（56%）相比，挽救性放疗后的患者（13%）使用尿失禁护垫的可能性更小。与挽救性放疗（61%）相比，挽救性手术后勃起功能障碍更为常见（81%）。原发性cT1-2期前列腺癌后的挽救性手术和挽救性前列腺切除术在初次治疗后提供了相当的无PSA复发生存率。与挽救性前列腺切除术组相比，挽救性放疗组的泌尿生殖功能得到了更好的保留。
