Department of Urology, San Giovanni Battista Hospital, Città Della Salute e della Scienza and University of Turin, Turin, Italy.
Department of Urology, Institut Paoli-Calmettes, Marseille, France.
World J Urol. 2019 Aug;37(8):1517-1534. doi: 10.1007/s00345-019-02642-9. Epub 2019 Feb 1.
Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown.
To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT.
A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an 'a priori protocol'. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT.
Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7-62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6-38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed.
Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.
局限性前列腺癌根治性治疗（FT）后，是否会危及后续有需要时的前列腺癌（PCa）挽救性治疗，仍是一个主要关注点，且很大程度上尚未可知。
描述和报告 PCa 根治性治疗后复发/持续存在患者接受挽救性治疗的安全性、肿瘤学和功能结局。
根据 PRISMA 指南，使用预先制定的方案，对 FT 后 PCa 复发/持续存在患者接受挽救性治疗的相关研究进行系统综述。还进行了全面的文献综述，以调查 FT 后尚未报道的局限性 PCa 复发/持续存在的治疗选择。
共纳入 4 项回顾性系列研究（n=67 例男性）；研究总体质量较低。挽救性治疗后，在平均 7-62 个月的随访期间，生化复发率（BCR）为 32.8%（n=67 例中的 22 例）。未发生与癌症相关的死亡。患者经历了可接受的并发症（n=12 例患者；n=8 例 Clavien 3 级）和罕见的严重尿失禁（4.5%每天使用>2 片尿垫）。性功能（EF）很少评估（62.8%无信息可用），总体较差。全腺体消融后的其他挽救性治疗选择包括：（1）再次消融导致最差的 BCR 和 EF，但与一线消融相比，并发症和尿失禁相似；（2）挽救性放疗导致 16.6-38.8%的 BCR，且具有可接受的毒性特征，对尿失禁和 EF 的评估较差。
目前的证据很薄弱，仅限于少数回顾性系列研究。肿瘤控制可接受，尽管似乎低于原发性治疗。功能结局与原发性治疗相当，除了 EF；总体而言，表明 FT 对后续挽救性治疗的影响较小。需要进一步的研究来证实目前的发现。
