Storino Ramacciotti Lorenzo, Abreu Andre Luis, Crouzet Sébastien, Macek Petr, Miles Brian J, Horuz Rahim, Nunes-Carneiro Diogo, Stricker Phillip, Scionti Stephen, Laguna M Pilar
USC Institute of Urology and Catherine & Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Department of Urology, Edouard Herriot Hospital, University of Lyon, Lyon, France.
Prostate Cancer Prostatic Dis. 2024 Aug 1. doi: 10.1038/s41391-024-00875-3.
To review the literature on salvage treatments after focal therapy (FT) for prostate cancer (PCa).
A non-systematic literature review was conducted on PubMed, Scopus, and Web of Science up to March 15, 2024, for studies that assessed salvage treatment outcomes in patients with recurrent PCa after primary FT. Original prospective and retrospective studies with more than 10 patients were included. Reviews, editorial comments, conference abstracts, and studies focusing solely on whole-gland treatments were excluded.
Twenty-one studies with a total of 1012 patients were included. The most reported salvage treatments were salvage radical prostatectomy followed by re-do ablation therapy. Only one study evaluated salvage radiation therapy. Except for one prospective study, all studies were retrospective. Oncological outcomes showed acceptable biochemical recurrence rates. Functional outcomes varied, with significant impacts observed on erectile function across modalities, though continence rates were less impacted. Complications were generally low across all treatment options.
Salvage treatment post-primary FT is feasible, safe, and has reasonable oncologic outcomes. However, significant declines in sexual function are common, while continence is comparatively less affected. The literature primarily consists of retrospective studies; hence, future research should focus on large-scale prospective evaluations to better define treatment protocols and improve patient outcomes.
回顾前列腺癌（PCa）聚焦治疗（FT）后挽救性治疗的相关文献。
截至2024年3月15日，在PubMed、Scopus和Web of Science上进行了非系统性文献综述，以查找评估原发性FT后复发性PCa患者挽救性治疗结果的研究。纳入了患者超过10例的原始前瞻性和回顾性研究。排除综述、编辑评论、会议摘要以及仅关注全腺治疗的研究。
纳入了21项研究，共1012例患者。报道最多的挽救性治疗是挽救性根治性前列腺切除术，其次是再次消融治疗。仅有一项研究评估了挽救性放射治疗。除一项前瞻性研究外，所有研究均为回顾性研究。肿瘤学结果显示生化复发率可接受。功能结果各不相同，各治疗方式对勃起功能均有显著影响，不过控尿率受影响较小。所有治疗方案的并发症总体发生率较低。
原发性FT后的挽救性治疗可行、安全，且肿瘤学结果合理。然而，性功能显著下降较为常见，而控尿功能相对受影响较小。文献主要由回顾性研究组成；因此，未来的研究应侧重于大规模前瞻性评估，以更好地确定治疗方案并改善患者预后。
