Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy.
Department of Urology, Mayo Clinic, Rochester, MN, USA.
World J Urol. 2019 Aug;37(8):1469-1483. doi: 10.1007/s00345-019-02749-z. Epub 2019 Apr 6.
Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP.
A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible.
sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1% of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60%, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50% and 5-year cancer-specific survival rates are around 90%. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60%. Potency remains difficult to recover.
sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.
挽救性前列腺切除术（sRP）代表了放射治疗（RT）后前列腺癌（PCa）生化复发（BCR）的一种治愈选择。在这篇综述中，我们旨在概述 sRP 的当代结果和应用。
我们在 Ovid 平台上使用 Embase 和 Medline 数据库进行了网络搜索，使用预定义的搜索词从 2010 年 1 月开始。网络搜索通过手动搜索进行。在可行的情况下，使用标准分类系统总结了肿瘤学和功能结果以及并发症。
sRP 目前应用不足，仅约 1%的放射性复发性 PCa 患者选择接受该手术。由于放射诱导的组织变化，手术变得复杂，使得后平面和顶点解剖特别具有挑战性。患者选择对于最大限度地提高肿瘤学获益至关重要。大多数系列报告的 BCR 无复发生存率>60%，主要在短至中期随访结束时。5 年无进展生存率接近 50%，5 年癌症特异性生存率约为 90%。主要围手术期并发症（吻合口漏和狭窄）仍比原发性 RP 更为常见，但近年来与历史系列相比，其发生率有所降低。控尿率差异很大，通常在 39%至 60%之间。勃起功能仍然难以恢复。
sRP 代表了一种有前途的短至中期肿瘤学结果和可接受的副作用的治愈选择，在高容量机构中。在适当选择的患者中，不应因担心功能结果不佳和/或并发症而过度应用该手术。需要前瞻性研究来评估长期结果，并进一步细化患者选择标准。
