Blank Fernando, Meyer Meredith, Wang Hannah, Abbas Hasan, Tayebi Shima, Hsu Wei-Wen, Sidana Abhinav
Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
Cancers (Basel). 2023 May 12;15(10):2727. doi: 10.3390/cancers15102727.
Focal therapy (FT) has been gaining popularity as a treatment option for localized intermediate-risk prostate cancer (PCa) due to the associated lower morbidity compared to whole-gland treatment. However, there is an increased risk of local cancer recurrence requiring subsequent treatment in a small proportion of patients.
To conduct a systematic review and meta-analysis to better describe and analyze patient postoperative, oncologic, and functional outcomes for those who underwent salvage radical prostatectomy (sRP) to manage their primary FT failure.
A systematic review was completed using three databases (PubMed, Embase, and CINAHL) from October to December 2021 to identify data on outcomes in patients who received sRP for cancer recurrence after prior focal treatment.
12 articles (482 patients) were included. Median time to sRP was 24 months. Median follow-up time was 27 months. A meta-analysis revealed a postoperative complication rate of 15% (95% CI: 0.09, 0.24), with 4.6% meeting criteria for a major complication Clavien (CG) grade ≥3. Severe GU toxicity was seen in 3.6% of the patients, and no patients had severe GI toxicity. Positive surgical margins (PSM) were found in 27% (95% CI: 0.19, 0.37). Biochemical recurrence (BCR) after sRP occurred in 23% (95% CI: 0.17, 0.30), indicating a BCR-free probability of 77% at 2 years. Continence (pad-free) and potency (ability to have penetrative sex) were maintained in 67% (95% CI: 0.53, 0.78) and 37% (95% CI: 0.18, 0.62) at 12 months, respectively.
Our evidence shows acceptable complication rates and oncologic outcomes; however, with suboptimal functional outcomes for patients undergoing sRP for recurrent PCa after prior FT. Inferior outcomes were observed for salvage treatment compared to primary radical prostatectomy (pRP). More high-quality studies are needed to better characterize outcomes after this sequence of PCa treatments.
We looked at treatment outcomes and toxicity for men treated with sRP for prior FT failure. We conclude that these patients will have significant detriment to genitourinary function, with outcomes being worse than those for pRP patients.
聚焦治疗（FT）作为局限性中危前列腺癌（PCa）的一种治疗选择，因其与全腺治疗相比发病率较低而越来越受欢迎。然而，一小部分患者局部癌症复发需要后续治疗的风险增加。
进行系统评价和荟萃分析，以更好地描述和分析接受挽救性根治性前列腺切除术（sRP）以处理原发性FT失败的患者的术后、肿瘤学和功能结局。
2021年10月至12月使用三个数据库（PubMed、Embase和CINAHL）完成了一项系统评价，以确定先前接受聚焦治疗后因癌症复发接受sRP的患者的结局数据。
纳入12篇文章（482例患者）。sRP的中位时间为24个月。中位随访时间为27个月。荟萃分析显示术后并发症发生率为15%（95%CI：0.09，0.24），4.6%符合Clavien（CG）≥3级重大并发症标准。3.6% 的患者出现严重泌尿生殖系统毒性，无患者出现严重胃肠道毒性。27%（95%CI：0.19，0.37）发现手术切缘阳性（PSM）。sRP后生化复发（BCR）发生率为23%（95%CI：0.17，0.30），表明2年时无BCR的概率为77%。12个月时，67%（95%CI：0.53，0.78）和37%（95%CI：0.18，0.62）的患者分别保持了控尿（无尿垫）和性功能（进行插入式性行为的能力）。
我们的证据显示并发症发生率和肿瘤学结局可接受；然而，先前接受FT后复发PCa的患者接受sRP后的功能结局欠佳。与原发性根治性前列腺切除术（pRP）相比，挽救性治疗的结局较差。需要更多高质量的研究来更好地描述这一PCa治疗序列后的结局。
我们研究了先前FT失败后接受sRP治疗的男性的治疗结局和毒性。我们得出结论，这些患者的泌尿生殖功能将受到重大损害，结局比pRP患者更差。
