Hospital Israelita Albert Einstein, Department of Urology, São Paulo, São Paulo.
Hospital Cardiopulmonar, Department of Urology, Salvador, Bahia.
Urol Oncol. 2024 Dec;42(12):449.e1-449.e11. doi: 10.1016/j.urolonc.2024.08.011. Epub 2024 Sep 10.
To evaluate the role of salvage local treatment in managing recurrent PCa following FT, focusing on oncological and functional outcomes.
A systematic review and meta-analysis were performed following the PRISMA framework. A comprehensive literature search using the PubMed/MEDLINE and EMBASE databases was performed until July 2023. Eligible studies included patients with clinically localised PCa initially treated with FT, who experienced relapse during surveillance and subsequently underwent salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT) or salvage focal therapy (sFT). The primary endpoint was the biochemical recurrence rate post-salvage treatment. The secondary endpoints were functional outcomes, including urinary incontinence and erectile dysfunction rates.
In 26 retrospective studies including 990 patients, the overall pooled biochemical recurrence rate postsalvage treatment was 26%. The subgroup analysis revealed a biochemical recurrence rate of 20%, 22%, and 42% after sRP, sEBRT, and sFT, respectively. The overall pooled rate of urinary incontinence was 20%. Salvage FT had the lowest prevalence of urinary incontinence, followed by sRP and sEBRT. The overall pooled rate of erectile dysfunction was 43%. Salvage RP had the highest prevalence of erectile dysfunction, followed by sFT and sEBRT. Substantial heterogeneity was observed among the studies, primarily due to different sample sizes. Meta-regression analysis revealed no to low contributions of salvage treatment modalities, extent of ablation, age, prostatic specific antigen level before salvage treatment, proportion of patients with Gleason score ≥7 at recurrence, and time between the primary and salvage therapies to heterogeneity.
Salvage local treatment for recurrent PCa after FT is feasible, and it provides acceptable oncological and functional outcomes. Among all treatment modalities, sRP and sEBRT appeared to have the lowest biochemical recurrence rates, whereas sFT was associated with improved functional outcomes.
评估挽救性局部治疗在处理 FT 后复发性前列腺癌中的作用，重点关注肿瘤学和功能结果。
根据 PRISMA 框架进行系统评价和荟萃分析。使用 PubMed/MEDLINE 和 EMBASE 数据库进行全面的文献检索，截至 2023 年 7 月。纳入的研究包括最初接受 FT 治疗的临床局限性前列腺癌患者，这些患者在监测期间复发，随后接受挽救性根治性前列腺切除术（sRP）、挽救性外照射放疗（sEBRT）或挽救性局部治疗（sFT）。主要终点是挽救性治疗后的生化复发率。次要终点是功能结果，包括尿失禁和勃起功能障碍的发生率。
在包括 990 例患者的 26 项回顾性研究中，挽救性治疗后总的生化复发率为 26%。亚组分析显示，sRP、sEBRT 和 sFT 后生化复发率分别为 20%、22%和 42%。总的尿失禁发生率为 20%。挽救性 FT 的尿失禁发生率最低，其次是 sRP 和 sEBRT。总的勃起功能障碍发生率为 43%。挽救性 RP 的勃起功能障碍发生率最高，其次是 sFT 和 sEBRT。研究之间存在显著的异质性，主要是由于样本量不同。元回归分析显示，挽救性治疗方式、消融范围、年龄、挽救性治疗前前列腺特异性抗原水平、复发时 Gleason 评分≥7 的患者比例以及原发和挽救性治疗之间的时间对异质性的贡献不大或低。
FT 后复发性前列腺癌的挽救性局部治疗是可行的，并且提供了可接受的肿瘤学和功能结果。在所有治疗方式中，sRP 和 sEBRT 似乎具有最低的生化复发率，而 sFT 与改善的功能结果相关。
