Service dúrologie, chirurgie de la transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
LabTAU, INSERM, Université Lyon 1, Lyon, France.
J Urol. 2021 Aug;206(2):325-337. doi: 10.1097/JU.0000000000001771. Epub 2021 Apr 9.
We sought to report the preliminary results of salvage high-intensity focused ultrasound for locally recurrent prostate cancer in the prostatic bed after radical prostatectomy and adjuvant or salvage radiotherapy.
We retrospectively analyzed a single-center cohort of men treated with salvage high-intensity focused ultrasound for locally recurrent prostate cancer after radical prostatectomy and adjuvant or salvage radiotherapy. All patients had a combination of choline positron emission tomography, multiparametric magnetic resonance imaging, and transrectal biopsies to confirm the local recurrence. Treatment failure was defined as persistent or recurrent prostate cancer in the prostatic bed and/or metastasis and/or introduction of systemic treatment. Progression was defined as metastasis and/or introduction of systemic treatment. Complications (Clavien-Dindo classification) and continence (Ingelman-Sundberg score) were evaluated. Kaplan-Meier analysis estimated oncological outcomes.
Between July 2009 and November 2018, 22 patients were included; the median followup was 2.32 years. At 3 years, treatment failure-free survival rate was estimated to be 49.7% and progression-free survival rate 60.4%. Prostate specific antigen nadir ≤0.2 ng/ml was reached in 50% of the patients. A nadir of ≤0.2 ng/ml was significantly associated with better treatment failure-free and progression-free survival probabilities (p=0.003 and p=0.037, respectively). Grade III complications occurred in 6 patients (27.3%). Onset of grade II-III incontinence was significantly more frequent in cases of perianastomotic (36.4%) compared to retrovesical recurrence (0%; p=0.027).
Salvage high-intensity focused ultrasound for locally recurrent prostate cancer after radical prostatectomy and salvage radiotherapy showed encouraging oncological results despite significant morbidity. The perianastomotic recurrence was linked to a higher risk of incontinence.
我们旨在报告根治性前列腺切除术后和辅助或挽救性放疗后前列腺床局部复发性前列腺癌行挽救性高强度聚焦超声治疗的初步结果。
我们回顾性分析了单中心队列中接受挽救性高强度聚焦超声治疗根治性前列腺切除术后和辅助或挽救性放疗后局部复发性前列腺癌的男性患者。所有患者均通过胆碱正电子发射断层扫描、多参数磁共振成像和经直肠活检相结合来确认局部复发。治疗失败定义为前列腺床内持续性或复发性前列腺癌和/或转移和/或引入全身治疗。进展定义为转移和/或引入全身治疗。评估并发症（Clavien-Dindo 分类）和尿控（Ingelman-Sundberg 评分）。Kaplan-Meier 分析估计肿瘤学结果。
2009 年 7 月至 2018 年 11 月，共纳入 22 例患者；中位随访时间为 2.32 年。3 年时，无治疗失败生存率估计为 49.7%，无进展生存率为 60.4%。50%的患者达到前列腺特异性抗原（PSA）最低值<0.2ng/ml。PSA 最低值<0.2ng/ml 与更好的无治疗失败和无进展生存概率显著相关（p=0.003 和 p=0.037）。6 例（27.3%）发生 III 级并发症。吻合口周围复发（36.4%）比后尿道复发（0%）发生 II-III 级尿失禁的发生率明显更高（p=0.027）。
根治性前列腺切除术后和挽救性放疗后局部复发性前列腺癌行挽救性高强度聚焦超声治疗显示出令人鼓舞的肿瘤学结果，尽管发病率较高。吻合口周围复发与更高的尿失禁风险相关。
