Chesapeake Urology Associates, Silver Spring, MD, USA.
Cleveland Clinic Florida, Department of Urology, Weston, FL, USA.
Prostate Int. 2016 Mar;4(1):7-10. doi: 10.1016/j.prnil.2015.11.002. Epub 2015 Dec 17.
Although primary treatment of localized prostate cancer provides excellent oncologic control, some men who chose radiotherapy experience a recurrence of disease. There is no consensus on the most appropriate management of these patients after radiotherapy failure. In this single-institution review, we compare our oncologic outcome and toxicity between salvage prostatectomy and cryotherapy treatments.
From January 2004 to June 2013, a total of 23 salvage procedures were performed. Six of those patients underwent salvage prostatectomy while 17 underwent salvage cryotherapy by two high-volume fellowship-trained urologists. Patients being considered for salvage therapy had localized disease at presentation, a prostate-specific antigen (PSA) < 10 ng/mL at recurrence, life expectancy > 10 years at recurrence, and a negative metastatic workup. Patients were followed to observe cancer progression and toxicity of treatment.
Patients who underwent salvage cryotherapy were statistically older with a higher incidence of hypertension than our salvage prostatectomy cohort. With a mean follow up of 14.1 months and 7.2 months, the incidence of disease progression was 23.5% and 16.7% after salvage cryotherapy and prostatectomy, respectively. The overall complication rate was also 23.5% versus 16.7%, with the most frequent complication after salvage cryotherapy being urethral stricture and after salvage prostatectomy being severe urinary incontinence. There were no rectal injuries with salvage prostatectomy and one rectourethral fistula in the cohort after salvage cryotherapy.
While recurrences from primary radiotherapy for prostate cancer do occur, there is no consensus on its management. In our experience, salvage procedures were generally safe and effective. Both salvage cryotherapy and salvage prostatectomy allow for adequate cancer control with minimal toxicity.
尽管局部前列腺癌的初始治疗可提供出色的肿瘤控制效果，但一些选择放疗的患者会出现疾病复发。对于这些放疗后复发的患者，目前尚无关于最佳治疗方法的共识。在本单中心回顾性研究中，我们比较了挽救性前列腺切除术和冷冻治疗在肿瘤学结果和毒性方面的差异。
从 2004 年 1 月至 2013 年 6 月，共进行了 23 例挽救性手术。其中 6 例患者接受了挽救性前列腺切除术，17 例患者由 2 名接受过冷冻治疗培训的高年资泌尿科医生实施了挽救性冷冻治疗。选择接受挽救性治疗的患者在初次就诊时表现为局限性疾病，复发时前列腺特异性抗原（PSA）<10ng/ml，复发时预期寿命>10 年，且转移灶检查为阴性。对患者进行随访，以观察癌症进展和治疗毒性。
接受挽救性冷冻治疗的患者在统计学上比接受挽救性前列腺切除术的患者年龄更大，且高血压的发病率更高。挽救性冷冻治疗和前列腺切除术组的平均随访时间分别为 14.1 个月和 7.2 个月，疾病进展的发生率分别为 23.5%和 16.7%。挽救性冷冻治疗和前列腺切除术组的总体并发症发生率分别为 23.5%和 16.7%，挽救性冷冻治疗后最常见的并发症是尿道狭窄，挽救性前列腺切除术后最常见的并发症是严重尿失禁。挽救性前列腺切除术后无直肠损伤，挽救性冷冻治疗组发生 1 例直肠尿道瘘。
尽管原发性放疗后前列腺癌确实会复发，但目前尚无关于其治疗方法的共识。根据我们的经验，挽救性手术通常是安全有效的。挽救性冷冻治疗和挽救性前列腺切除术都能有效地控制癌症，且毒性较小。
