Lama Daniel J, Thomas Kyle, Ferenczi Basil, Okunowo Oluwatimilehin, Lau Clayton S, Yuh Bertram E
Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA.
Eur Urol Open Sci. 2023 Dec 30;60:1-7. doi: 10.1016/j.euros.2023.11.011. eCollection 2024 Feb.
Approximately two-thirds of men who undergo primary treatment for prostate cancer (PC) will experience biochemical recurrence (BCR). Salvage robot-assisted radical prostatectomy (sRARP) offers curative treatment in this disease setting and men who choose this option may avoid palliative androgen deprivation therapy (ADT). The purpose of this study was to describe long-term outcomes and patient feedback following sRARP.
We reviewed data for consecutive men with biopsy-proven localized BCR who underwent sRARP and pelvic lymph node dissection at a single tertiary referral center between 2004 and 2021. Perioperative data, Clavien-Dindo complications, and functional outcomes were recorded The Kaplan-Meier method was used to estimate prostate-specific antigen-free (≥0.2 ng/ml) survival (PSAFS) and metastasis-free survival (MFS). Three Likert-type items (score 1-5) from the validated Surgical Satisfaction Questionnaire-8 were distributed to patients postoperatively.
We included 78 men, of whom 72 (92%) had undergone primary radiotherapy and six (8%) had received primary prostate ablation. Median follow-up was 10.1 yr (interquartile range 5.8-12.4). Final pathology identified ≥pT3N0M0 in 35 patients (45%) and positive margins in 23 (29%). The overall complication rate was 50%. Of the 26 (33%) major (grade ≥III) complications, anastomotic stricture (32%) was most common. The estimated 3-, 5-, and 10-yr survival rates were 85.6% and 80.2%, 83.5% for PSAFS ( = 11), and 74.1%, 83.5%, and 70.5% for MFS ( = 23), respectively. At last follow-up, postoperative ADT had been administered to 17 patients (22%), and 39 men (50%) remained alive a decade after sRARP. Continence and potency were maintained in 33/62 (53%) and 1/16 (6%) patients, respectively. Thirty-five respondents (45%) reported median questionnaire scores (≥4) in favor of sRARP. Limitations include the small single-center series and a single query point for patient feedback.
Long-term outcomes of sRARP suggest that the technical challenges and morbidity of the procedure are qualified by patient feedback and the opportunity to evade the morbidity and mortality of biochemically recurrent PC.
We reviewed the cancer outcomes and side effects of robot-assisted surgical removal of the prostate after treatment failure with radiation or ablation for prostate cancer. We found that this type of treatment has substantial risks and long-term side effects, but the surgery provides an opportunity to cure prostate cancer and/or avoid the consequences of indefinite hormonal treatment. Overall, most men who underwent this surgery were not disappointed with their decision despite the higher risks and consequences.
接受前列腺癌（PC）初次治疗的男性中，约三分之二会出现生化复发（BCR）。挽救性机器人辅助根治性前列腺切除术（sRARP）为这种疾病提供了治愈性治疗，选择该方案的男性可以避免姑息性雄激素剥夺治疗（ADT）。本研究的目的是描述sRARP后的长期结局和患者反馈。
我们回顾了2004年至2021年间在单一三级转诊中心接受sRARP和盆腔淋巴结清扫的经活检证实为局限性BCR的连续男性患者的数据。记录围手术期数据、Clavien-Dindo并发症和功能结局。采用Kaplan-Meier法估计无前列腺特异性抗原（≥0.2 ng/ml）生存期（PSAFS）和无转移生存期（MFS）。术后向患者发放经过验证的手术满意度问卷-8中的三个李克特式项目（评分1-5）。
我们纳入了78名男性，其中72名（92%）接受过初次放疗，6名（8%）接受过初次前列腺消融。中位随访时间为10.1年（四分位间距5.8-12.4）。最终病理显示35例患者（45%）为≥pT3N0M0，23例（29%）切缘阳性。总体并发症发生率为50%。在26例（33%）严重（≥III级）并发症中，吻合口狭窄（32%）最为常见。估计3年、5年和10年的PSAFS生存率分别为85.6%、80.2%、83.5%（n = 11），MFS生存率分别为74.1%、83.5%、70.5%（n = 23）。在最后一次随访时，17例患者（22%）接受了术后ADT，39名男性（50%）在sRARP后十年仍存活。分别有33/62（53%）和1/16（6%）的患者保持了控尿和性功能。35名受访者（45%）报告问卷中位评分（≥4）支持sRARP。局限性包括单中心小样本系列以及单一的患者反馈询问点。
sRARP的长期结局表明，该手术的技术挑战和发病率因患者反馈以及避免生化复发PC的发病率和死亡率的机会而得到弥补。
我们回顾了前列腺癌放疗或消融治疗失败后机器人辅助手术切除前列腺的癌症结局和副作用。我们发现这种治疗有重大风险和长期副作用，但手术提供了治愈前列腺癌和/或避免无限期激素治疗后果的机会。总体而言，尽管风险和后果较高，但大多数接受该手术的男性对自己的决定并不失望。
