Paparel Philippe, Cronin Angel M, Savage Caroline, Scardino Peter T, Eastham James A
Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Eur Urol. 2009 Feb;55(2):404-10. doi: 10.1016/j.eururo.2008.07.007. Epub 2008 Jul 14.
Limited data on patterns of recurrence (local or metastatic) after salvage radical prostatectomy (SP) is available.
To examine biochemical, local and metastatic patterns of recurrence in patients undergoing SP for radiation-recurrent prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS: 146 patients with biopsy-proven local recurrence of prostate cancer after radiation therapy treated with SP were evaluated in a retrospective study at a single institution.
All patients underwent SP by mainly two surgeons.
Biochemical recurrence (BCR) after SP was defined as a serum prostate-specific antigen (PSA) level of >or=0.2 ng/ml or was defined by the initiation of androgen deprivation therapy. All predictors analyzed were determined after radiotherapy, before SP, and included PSA level, clinical stage, biopsy Gleason score, age at SP, and time interval from radiotherapy to SP.
Of the 146 patients treated with SP, 65 developed BCR. The median follow-up period for recurrence-free patients was 3.8 yr; 43 patients (29%) were followed for >5 yr. Overall, the 5-yr recurrence-free probability was 54% (95% CI, 44-63%). Clinical local recurrence occurred in only one patient who also had bone metastases. Overall, there were 16 prostate cancer-specific deaths and 19 deaths from other causes. The 5-yr cumulative incidence of death from prostate cancer was 4% (95% CI, 2-11%). Pre-SP serum PSA level and biopsy Gleason score were significantly associated with death due to prostate cancer (p<0.0005 and p=0.002, respectively). This study is retrospective and included carefully selected patients treated over a long period by, mainly, two experienced surgeons.
SP provides excellent local cancer control; only one patient in our series experienced a clinical local recurrence. Earlier identification of patients with persistent, viable local cancer despite radiation therapy will appropriately select patients for SP.
关于挽救性根治性前列腺切除术（SP）后复发模式（局部或转移）的数据有限。
研究接受SP治疗放射性复发前列腺癌患者的生化、局部和转移复发模式。
设计、场所和参与者：在一家单一机构进行的一项回顾性研究中，对146例经活检证实为放疗后前列腺癌局部复发并接受SP治疗的患者进行了评估。
所有患者主要由两位外科医生进行SP手术。
SP术后生化复发（BCR）定义为血清前列腺特异性抗原（PSA）水平≥0.2 ng/ml或因开始雄激素剥夺治疗而定义。所有分析的预测因素均在放疗后、SP术前确定，包括PSA水平、临床分期、活检Gleason评分、SP时年龄以及从放疗到SP的时间间隔。
在接受SP治疗的146例患者中，65例出现BCR。无复发患者的中位随访期为3.8年；43例患者（29%）随访时间超过5年。总体而言，5年无复发概率为54%（95%CI，44 - 63%）。仅1例患者出现临床局部复发且伴有骨转移。总体上，有16例前列腺癌特异性死亡和19例其他原因死亡。前列腺癌5年累积死亡率为4%（95%CI，2 - 11%）。SP术前血清PSA水平和活检Gleason评分与前列腺癌死亡显著相关（分别为p < 0.0005和p = 0.002）。本研究为回顾性研究，纳入的是经过精心挑选、主要由两位经验丰富的外科医生长期治疗的患者。
SP能实现良好的局部癌症控制；我们系列中仅1例患者出现临床局部复发。更早识别出尽管接受放疗但仍存在持续性、存活局部癌的患者，将有助于合理选择适合SP的患者。
