载培拉滨光动力疗法后行根治性前列腺切除术的可行性，以及早期和中期结果。

Radical Prostatectomy after Vascular Targeted Photodynamic Therapy with Padeliporfin: Feasibility, and Early and Intermediate Results.

机构信息

Department of Urology, Lyon Sud University Hospital, Lyon.

Departments of Urology, Angers University Hospital, Angers.

出版信息

J Urol. 2019 Feb;201(2):315-321. doi: 10.1016/j.juro.2018.08.084.

DOI:10.1016/j.juro.2018.08.084

PMID:30248343

Abstract

PURPOSE

Vascular targeted photodynamic therapy with TOOKAD® is a new therapeutic option for localized prostate cancer management. The objectives of this study were to assess the feasibility of radical prostatectomy after vascular targeted photodynamic therapy and describe functional and oncologic outcomes.

MATERIALS AND METHODS

We retrospectively included in study 45 patients who underwent salvage radical prostatectomy after vascular targeted photodynamic therapy for recurrent prostate cancer at a total of 14 surgical centers in Europe between October 2008 and March 2017. Of the 42 radical prostatectomies performed 16 were robot-assisted, 6 were laparoscopic and 20 were open surgery. Primary end points were morbidity and technical difficulties. Secondary end points were early and intermediate postoperative functional and oncologic outcomes.

RESULTS

Median operative time was 180 minutes (IQR 150-223). Median blood loss was 200 ml (IQR 155-363). According to the surgeons the surgery was easy in 29 patients (69%) and difficult in 13 (31%). Nerve sparing was feasible in 14 patients (33%). Five postoperative complications (12%) were found, including 2 Clavien I, 2 Clavien II and 1 Clavien IIIB complications. Of the cases 13 (31%) were pT3 and 21 (50%) were pT2c. Surgical margins were positive in 13 patients (31%). Prostate specific antigen was undetectable at 6 to 12 months in 37 patients (88%). Nine patients underwent complementary radiotherapy. Four patients had final prostate specific antigen greater than 0.2 ng/ml at a median followup of 23 months (IQR 12-36). At 1 year 27 patients (64%) were completely continent (no pads) and 10 (24%) had low incontinence (1 pad). Four patients (11%) recovered potency without treatment and 23 (64%) recovered potency with appropriate treatment.

CONCLUSIONS

Salvage radical prostatectomy after vascular targeted photodynamic therapy treatment was feasible and safe without difficulty for most of the surgeons.

摘要

目的

采用 TOOKAD®进行血管靶向光动力疗法是局部前列腺癌治疗的一种新的治疗选择。本研究的目的是评估血管靶向光动力疗法后行根治性前列腺切除术的可行性，并描述功能和肿瘤学结果。

材料和方法

我们回顾性地纳入了 45 例患者，这些患者于 2008 年 10 月至 2017 年 3 月期间在欧洲的 14 个外科中心共进行了 42 例挽救性根治性前列腺切除术，这些患者因复发性前列腺癌接受了血管靶向光动力疗法治疗。在进行的 42 例根治性前列腺切除术中，有 16 例为机器人辅助手术，6 例为腹腔镜手术，20 例为开放手术。主要终点为发病率和技术难度。次要终点为早期和中期术后功能和肿瘤学结果。

结果

中位手术时间为 180 分钟（IQR 150-223）。中位失血量为 200ml（IQR 155-363）。根据外科医生的评估，29 例（69%）手术容易，13 例（31%）手术困难。14 例（33%）可行神经保留。术后发现 5 例并发症（12%），包括 2 例 Clavien I 级、2 例 Clavien II 级和 1 例 Clavien IIIB 级并发症。13 例（31%）为 pT3，21 例（50%）为 pT2c。13 例（31%）切缘阳性。37 例（88%）患者在 6-12 个月时前列腺特异性抗原不可检测。9 例患者接受了补充放疗。在中位随访 23 个月（IQR 12-36）时，4 例患者最终前列腺特异性抗原大于 0.2ng/ml。1 年后，27 例（64%）患者完全无尿失禁（无尿垫），10 例（24%）轻度尿失禁（1 个尿垫）。4 例（11%）患者未经治疗恢复勃起功能，23 例（64%）患者经适当治疗恢复勃起功能。