Corcoran Niall M, Godoy Guilherme, Studd Rodney C, Casey Rowan G, Hurtado-Coll Antonio, Tyldesley Scott, Goldenberg S Larry, Gleave Martin E
Department of Urological Sciences and Vancouver Prostate Centre, University of British Columbia, Vancouver, BC;
Department of Radiation Oncology, BC Cancer Agency, Vancouver, BC.
Can Urol Assoc J. 2013 Mar-Apr;7(3-4):87-92. doi: 10.5489/cuaj.11056.
Prostate cancer recurrence following primary radiation is common. If the recurrence remains localized to the prostate gland, surgical removal may result in long-term local control or cure. Despite the well-established oncological outcomes, salvage prostatectomy is infrequently performed or reported. We present our experience with salvage prostatectomy at a Canadian centre.
We identified all patients undergoing salvage prostatectomy at the Vancouver General Hospital between 1995 and 2010 from a prospectively recorded and maintained prostate cancer database. Details regarding initial presentation, delivery of radiotherapy, clinical features at the time of recurrence, as well as oncological and functional outcomes, were collected. Information regarding postoperative morbidity was collected prospectively and confirmed by retrospective chart review.
Over a 15-year period, salvage prostatectomy was successfully completed in 21 patients. With a median follow-up period of 68 months (range: 2-122), 9 (43%) patients experienced a biochemical recurrence, with most failing within the first 2 years of surgery. There were 3 deaths in the cohort, all from prostate cancer, giving a prostate cancer specific and overall survival of 86%. The main postoperative morbidity was bladder neck contracture, occurring in 40%. One patient each developed a recto-urethral fistula and osteitis pubis. Physician-recorded data regarding continence was available in 13 (62%). Of these 13 patients, 10 (85%) men were recorded as dry or using 1 pad per day.
This is the first Canadian centre to report that salvage prostatectomy can be performed with favourable oncological and functional outcomes.
原发性放疗后前列腺癌复发很常见。如果复发局限于前列腺，手术切除可能实现长期局部控制或治愈。尽管肿瘤学结果已得到充分证实，但挽救性前列腺切除术的实施和报道却很少见。我们介绍了加拿大一家中心开展挽救性前列腺切除术的经验。
我们从一个前瞻性记录和维护的前列腺癌数据库中，识别出1995年至2010年期间在温哥华总医院接受挽救性前列腺切除术的所有患者。收集了有关初始表现、放疗情况、复发时的临床特征以及肿瘤学和功能结果的详细信息。前瞻性收集了术后发病率信息，并通过回顾性病历审查进行确认。
在15年期间，21例患者成功完成了挽救性前列腺切除术。中位随访期为68个月（范围：2 - 122个月），9例（43%）患者出现生化复发，大多数在术后头2年内复发。该队列中有3例死亡，均死于前列腺癌，前列腺癌特异性生存率和总生存率为86%。主要术后并发症是膀胱颈挛缩，发生率为40%。各有1例患者发生直肠尿道瘘和耻骨炎。13例（62%）患者有医生记录的控尿数据。在这13例患者中，10例（85%）男性记录为无尿失禁或每天使用1片尿垫。
这是加拿大第一个报告挽救性前列腺切除术可取得良好肿瘤学和功能结果的中心。
