Khoo Christopher C, Miah Saiful, Connor Martin J, Tam Joseph, Winkler Mathias, Ahmed Hashim U, Shah Taimur T
Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
Transl Androl Urol. 2020 Jun;9(3):1535-1545. doi: 10.21037/tau.2019.08.21.
Although radiotherapy to the prostate for cancer is effective, recurrence occurs in 10-15% within 5 years. Traditional salvage treatments for men with radiorecurrent prostate cancer comprise of watchful waiting (WW) with or without androgen deprivation therapy (ADT) or radical prostatectomy (RP). Neither strategy provides ideal therapeutic ratios. Salvage focal ablation is an emerging option. We performed a systematic review of the Medline and Embase databases for studies reporting outcomes of focal salvage brachytherapy (sBT), cryotherapy (sCT) or high-intensity focused ultrasound (sHIFU) for radiorecurrent prostate cancer (conception to April 2019). Results were screened for inclusion against predetermined eligibility criteria. Certain data were extracted, including rates of biochemical disease-free survival (BDFS), metastasis, conversion to second-line therapies and adverse events. Of a total 134 articles returned from the search, 15 studies (14 case series and 1 comparative study) reported outcomes after focal sBT [5], sCT [7] and sHIFU [3]. Cohort size varied depending on intervention, with eligible studies of sBT being small case series. Median follow-up ranged from 10 to 56 months. Although pre-salvage demographics were similar [median age range, 61-75 years; prostate-specific antigen (PSA) range, 2.8-5.5 ng/mL], there was heterogeneity in patient selection, individual treatment protocols and outcome reporting. At 3 years, BDFS ranged from 61% to 71.4% after sBT, 48.1-72.4% after sCT and 48% after sHIFU. Only studies of sCT reported 5-year BDFS, which ranged from 46.5% to 54.4%. Rates of metastasis were low after all salvage modalities, as were conversion to second-line therapies (although this was poorly reported). Grade 3 adverse events were rare. This systematic review indicates that salvage focal ablation of radiorecurrent prostate cancer provides acceptable oncological outcomes and is well tolerated. Unfortunately, there is heterogeneity in the study design of existing evidence. Level 1 research comparing salvage focal therapies to existing whole-gland strategies is needed to further establish the role of these promising treatments.
尽管前列腺癌放射治疗有效，但5年内仍有10% - 15%的患者会复发。对于放射性复发前列腺癌男性患者，传统的挽救性治疗包括观察等待（WW），可联合或不联合雄激素剥夺治疗（ADT），或根治性前列腺切除术（RP）。这两种策略都未提供理想的治疗比率。挽救性局部消融是一种新兴选择。我们对Medline和Embase数据库进行了系统综述，以查找报告放射性复发前列腺癌局部挽救性近距离放疗（sBT）、冷冻治疗（sCT）或高强度聚焦超声（sHIFU）结果的研究（检索时间为从概念到2019年4月）。根据预先确定的纳入标准筛选结果。提取了某些数据，包括无生化疾病生存（BDFS）率、转移率、转换为二线治疗的情况以及不良事件。在检索返回的总共134篇文章中，15项研究（14个病例系列和1项比较研究）报告了局部sBT [5]、sCT [7]和sHIFU [3]后的结果。队列规模因干预措施而异，sBT的合格研究为小病例系列。中位随访时间为10至56个月。尽管挽救性治疗前的人口统计学特征相似[中位年龄范围为61 - 75岁；前列腺特异性抗原（PSA）范围为2.8 - 5.5 ng/mL]，但在患者选择、个体治疗方案和结果报告方面存在异质性。3年后，sBT后的BDFS范围为61%至71.4%，sCT后为48.1% - 72.4%，sHIFU后为48%。只有sCT的研究报告了5年BDFS，范围为46.5%至54.4%。所有挽救性治疗方式后的转移率都很低，转换为二线治疗的情况也是如此（尽管报告较少）。3级不良事件很少见。这项系统综述表明，放射性复发前列腺癌的挽救性局部消融提供了可接受的肿瘤学结果，且耐受性良好。不幸的是，现有证据的研究设计存在异质性。需要进行1级研究，将挽救性局部治疗与现有的全腺策略进行比较，以进一步确定这些有前景的治疗方法的作用。
