Seabra Daniel, Faria Eliney, Dauster Breno, Rodrigues Gunther, Fava Gilberto
Section of Urology, Pio XII Foundation, Barretos, Sao Paulo, Brazil.
Int Braz J Urol. 2009 Jan-Feb;35(1):43-8. doi: 10.1590/s1677-55382009000100007.
To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa).
From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year.
Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy, the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months.
SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.
严格评估挽救性根治性前列腺切除术（SRP）在复发性前列腺癌（PCa）患者治疗中的效果。
2005年1月至2007年6月，我们评估了复发性局限性PCa患者。当前列腺特异性抗原（PSA）在最低点后连续三次或更多次升高时，怀疑复发。在进行常规影像学检查且确诊为局限性PCa后，为患者提供SRP。手术后，我们评估出血、直肠损伤、尿失禁或梗阻以及阳痿情况。在术后1、3、6个月测量PSA值，此后每年测量两次。
42例患者接受了SRP。平均年龄为61岁。放疗后，PSA的平均最低点为1.5 ng/mL（0.57 - 5.5）。前列腺特异性抗原倍增时间（PSA-DT）的平均值为14个月（6 - 20）。在SRP之前，平均PSA为5.7 ng/mL（2.9 - 18）。病理分期为pT2a：13%；pT2b：34%；pT2c：27%；pT3a：13%；pT3b：13%。14%的病例出血>600 mL；50%出现尿道狭窄；72%出现尿失禁（每天使用两片或更多尿垫）。SRP后的平均随访时间为6至30个月。9例患者的PSA水平升高，其中6例的PSA-DT<10个月。
SRP是治疗局限性放射性抵抗性PCa的一种可行方法。PSA-DT已被证明对选择治疗方法很重要，如果PSA-DT>10个月，则不应进行SRP。由于其发病率增加，SRP应仅提供给更关注生存而非生活质量的患者。
