Lebdai Souhil, Villers Arnaud, Barret Eric, Nedelcu Cosmina, Bigot Pierre, Azzouzi Abdel-Rahmène
Urology Department, CHU Angers, 4 rue Larrey, 49933, Angers Cedex 9, France,
World J Urol. 2015 Jul;33(7):965-71. doi: 10.1007/s00345-015-1493-8. Epub 2015 Jan 23.
To investigate feasibility, safety, and efficacy of salvage radical prostatectomy (RP) for recurrent prostate cancer (PCa) after focal treatment with TOOKAD(®) Soluble vascular-targeted photodynamic therapy (VTP).
Nineteen patients underwent RP after biopsy-proven PCa post-focal VTP. We reported: operation time, blood loss, transfusion, complications, urethral catheterization time, functional outcomes, and short-term oncologic outcomes.
Median age was 64 years (58-70). Median PSA before VTP was 6.30 ng/ml (3.20-9.80). Median delay between VTP and RP was 17 months (8-48). Median blood loss was 400 ml (100-1,000). Median operation time was 150 min (90-210), median urethral catheterization time was 7 days (5-18), and median hospital stay was 7 days (4-21). There was no perioperative mortality. Three patients had related per-operative complications: one pelvic hematoma (150 cc) (Clavien IIIa), one per-operative transfusion (900 cc hemorrhage) (Clavien II), and one superficial wound infection (Clavien I). After a median follow-up of 10 months (1-46), 13 were completely continent (68 %), five needed ≤1 pad/day, and one needed 3 pads/day (Clavien I). Severe erectile dysfunction was observed before and after RP (respectively 8 and 18). Ten patients regained potency with appropriate treatment. Median postoperative PSA was 0.02 ng/ml (<0.01-0.38) and remained undetectable for 16 patients (84 %). Nine patients had positive margins and six underwent complementary radiotherapy. Positive margins were significantly associated with bilateral VTP [risk ratio = 4.3, 95 % confidence interval (1.6-11.7), p = 0.003].
Salvage RP after VTP treatment was feasible, safe, and efficient to treat most of the locally recurrent PCa. Short-term oncologic and functional outcomes were promising, but further studies are required.
探讨采用TOOKAD（®）可溶性血管靶向光动力疗法（VTP）进行局部治疗后，挽救性根治性前列腺切除术（RP）治疗复发性前列腺癌（PCa）的可行性、安全性和有效性。
19例经活检证实为局部VTP治疗后PCa的患者接受了RP手术。我们报告了：手术时间、失血量、输血情况、并发症、导尿时间、功能结局和短期肿瘤学结局。
中位年龄为64岁（58 - 70岁）。VTP前中位前列腺特异性抗原（PSA）为6.30 ng/ml（3.20 - 9.80）。VTP与RP之间的中位间隔时间为17个月（8 - 48个月）。中位失血量为400 ml（100 - 1000 ml）。中位手术时间为150分钟（90 - 210分钟），中位导尿时间为7天（5 - 18天），中位住院时间为7天（4 - 21天）。无围手术期死亡。3例患者出现相关手术并发症：1例盆腔血肿（150 cc）（Clavien IIIa级），1例术中输血（900 cc出血）（Clavien II级），1例表浅伤口感染（Clavien I级）。中位随访10个月（1 - 46个月）后，13例患者完全控尿（68%），5例患者每天需要≤1片尿垫，1例患者每天需要3片尿垫（Clavien I级）。RP前后均观察到严重勃起功能障碍（分别为8例和18例）。10例患者经适当治疗后恢复性功能。术后中位PSA为0.02 ng/ml（<0.01 - 0.38），16例患者（84%）仍检测不到。9例患者切缘阳性，6例接受了辅助放疗。切缘阳性与双侧VTP显著相关[风险比 = 4.3，95%置信区间（1.6 - 11.7），p = 0.003]。
VTP治疗后挽救性RP治疗大多数局部复发性PCa是可行、安全且有效的。短期肿瘤学和功能结局良好，但仍需进一步研究。
