Department of Radiation Therapy, Maisonneuve-Rosemont Hospital, 5415 Bd. de l'Assomption, Montreal, Quebec, Canada.
Cancer Treat Rev. 2010 Apr;36(2):91-100. doi: 10.1016/j.ctrv.2009.06.006. Epub 2010 Jan 25.
The management of prostate cancer (PC) recurrence after definitive radiation therapy (RT) is shifting and there is no consensus regarding the optimal strategy. The major challenge is determining the anatomical site of relapse. In case of biochemical relapse (BR), androgen deprivation therapy (ADT) is a non-curative option commonly used, while patients with a local PC recurrence could be managed through a curative intent. Based on a Pubmed data search, this manuscript focused on the management of post-RT local PC recurrences. In case of BR (nadir+2 ng/ml), classical imaging work-up is not contributive for PSA levels <10 ng/ml while new imaging investigations (diffusion MRI, 11C-choline PET) are more sensitive to detect local and distant recurrences at lower PSA levels. Positive prostate biopsies are the only method for confirming local recurrence, although this technique presents limitations. Primary PC presentation as well as PSA-related features (interval to failure, PSA kinetic) and patient features (life expectancy, urinary, sexual status) are important to consider. Results of curative salvage options (radical prostatectomy, cryotherapy, brachytherapy and high-intensity focused ultrasound-HIFU) are analyzed and discussed. Each of these therapies appears feasible and has its own set of experience and toxicity profile. Other therapeutic options (photodynamic therapy, ADT, observation) are discussed. Longer follow-up and mature series are needed to evaluate the optimal strategy and prospective trials are warranted. Each clinical situation should be discussed in a multidisciplinary setting. Different options should be explained to the patient and decision should be taken after balancing treatment outcomes with life expectancy.
根治性放疗后前列腺癌（PC）复发的管理正在发生变化，对于最佳策略尚无共识。主要的挑战是确定复发的解剖部位。在生化复发（BR）的情况下，雄激素剥夺治疗（ADT）是一种常用的非治愈性选择，而局部 PC 复发的患者可以通过治愈性意图进行治疗。基于 Pubmed 数据检索，本文主要关注根治性放疗后局部 PC 复发的管理。在 BR（最低点+2ng/ml）的情况下，经典的影像学检查对于 PSA 水平<10ng/ml 没有帮助，而新的影像学检查（扩散 MRI、11C-胆碱 PET）在 PSA 水平较低时对检测局部和远处复发更敏感。阳性前列腺活检是确认局部复发的唯一方法，尽管该技术存在局限性。原发 PC 表现以及 PSA 相关特征（失败间隔、PSA 动力学）和患者特征（预期寿命、尿、性功能状况）都需要考虑。分析和讨论了治愈性挽救治疗（根治性前列腺切除术、冷冻疗法、近距离放射治疗和高强度聚焦超声-HIFU）的结果。这些治疗方法中的每一种似乎都可行，都有其自身的经验和毒性特征。还讨论了其他治疗选择（光动力疗法、ADT、观察）。需要更长时间的随访和成熟的系列来评估最佳策略，并需要进行前瞻性试验。每种临床情况都应在多学科环境中进行讨论。应向患者解释不同的选择，并在平衡治疗结果与预期寿命后做出决策。
