Clinica Urologica I, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.
Curr Urol Rep. 2012 Jun;13(3):195-201. doi: 10.1007/s11934-012-0245-1.
Radiation therapy (RT) is one of the treatment options for prostate cancer (PCa). Transperineal low-dose rate brachytherapy (BT) is another safe and effective technique for low-risk PCa. Recurrence after RT for localized PCa can be defined by a PSA value of 2 ng/mL above the nadir after RT, and biochemical recurrence (BCR) rate after RT is 40-60 %. In case of radiorecurrent PCa, treatment options include salvage radical prostatectomy (RP), cryotherapy, high-intensity focused ultrasound (HIFU), and salvage BT. Only salvage RP has cancer control results for over 10-year follow-up in a substantial portion of patients (30-40 %). However, salvage RP is technically demanding, and experienced surgeons are needed; in fact, RT-induced cystitis, fibrosis, and tissue plane obliteration can lead to significant complications, such as rectal injuries, anastomotic stricture, and urinary incontinence. This review describes indications, oncologic and functional outcomes, surgical techniques, and complications of salvage robot-assisted RP.
放射治疗（RT）是前列腺癌（PCa）的治疗选择之一。经会阴低剂量率近距离治疗（BT）是治疗低危 PCa 的另一种安全有效的技术。RT 后局部 PCa 的复发可以定义为 RT 后 PSA 值比最低点升高 2ng/mL，RT 后生化复发（BCR）率为 40-60%。对于放射性复发性 PCa，治疗选择包括挽救性根治性前列腺切除术（RP）、冷冻治疗、高强度聚焦超声（HIFU）和挽救性 BT。只有挽救性 RP 在很大一部分患者（30-40%）的 10 年以上随访中具有癌症控制结果。然而，挽救性 RP 技术要求高，需要有经验的外科医生；事实上，RT 引起的膀胱炎、纤维化和组织平面破坏会导致严重的并发症，如直肠损伤、吻合口狭窄和尿失禁。本文综述了挽救性机器人辅助 RP 的适应证、肿瘤学和功能结果、手术技术和并发症。
