Zattoni Fabio, Heidegger Isabel, Kasivisvanathan Veeru, Kretschmer Alexander, Marra Giancarlo, Magli Alessandro, Preisser Felix, Tilki Derya, Tsaur Igor, Valerio Massimo, van den Bergh Roderick, Kesch Claudia, Ceci Francesco, Fankhauser Christian, Gandaglia Giorgio
Urology Unit, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy.
Department of Urology, Medical University Innsbruck, Innsbruck, Austria.
Front Surg. 2021 Jul 9;8:691473. doi: 10.3389/fsurg.2021.691473. eCollection 2021.
The role and timing of radiotherapy (RT) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) remains controversial. While recent trials support the oncological safety of early salvage RT (SRT) compared to adjuvant RT (ART) in selected patients, previous randomized studies demonstrated that ART might improve recurrence-free survival in patients at high risk for local recurrence based on adverse pathology. Although ART might improve survival, this approach is characterized by a risk of overtreatment in up to 40% of cases. SRT is defined as the administration of RT to the prostatic bed and to the surrounding tissues in the patient with PSA recurrence after surgery but no evidence of distant metastatic disease. The delivery of salvage therapies exclusively in men who experience biochemical recurrence (BCR) has the potential advantage of reducing the risk of side effects without theoretically compromising outcomes. However, how to select patients at risk of progression who are more likely to benefit from a more aggressive treatment after RP, the exact timing of RT after RP, and the use of hormone therapy and its duration at the time of RT are still open issues. Moreover, what the role of novel imaging techniques and genomic classifiers are in identifying the most optimal post-operative management of PCa patients treated with RP is yet to be clarified. This narrative review summarizes most relevant published data to guide a multidisciplinary team in selecting appropriate candidates for post-prostatectomy radiation therapy.
在接受根治性前列腺切除术（RP）的前列腺癌（PCa）患者中，放疗（RT）的作用和时机仍存在争议。虽然最近的试验支持在特定患者中，与辅助放疗（ART）相比，早期挽救性放疗（SRT）的肿瘤学安全性，但先前的随机研究表明，基于不良病理结果，ART可能会改善局部复发高风险患者的无复发生存率。尽管ART可能会提高生存率，但这种方法的特点是在高达40%的病例中存在过度治疗的风险。SRT的定义是在手术后出现PSA复发但无远处转移疾病证据的患者中，对前列腺床和周围组织进行放疗。仅对发生生化复发（BCR）的男性进行挽救性治疗具有降低副作用风险的潜在优势，且理论上不会影响治疗效果。然而，如何选择有进展风险且更有可能从RP后更积极治疗中获益的患者、RP后放疗的确切时机、放疗时激素治疗的使用及其持续时间，仍然是悬而未决的问题。此外，新型成像技术和基因组分类器在确定接受RP治疗的PCa患者的最佳术后管理中的作用尚待阐明。本叙述性综述总结了最相关的已发表数据，以指导多学科团队选择前列腺切除术后放射治疗的合适候选者。
