Department of Urology, Clinico San Carlos University Hospital, Madrid, Spain.
Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
World J Urol. 2024 Sep 11;42(1):515. doi: 10.1007/s00345-024-05199-4.
The aim of this study is to compare outcomes of SRP (salvage radical prostatectomy) with SCAP (salvage cryoablation of the prostate) in local radio-recurrent PCa (prostate cancer) patients.
A retrospective analysis of a multicentric European Society of Uro-technology (ESUT) database was performed. Data on patients with local recurrent PCa after radiotherapy who underwent salvage treatment were collected. Patients and their respective disease characteristics, perioperative complications as well as oncological outcomes were then described. The treatment success rate was defined as PSA nadir < 0,4 ng/ml. Any complications were graded according to the modified Clavien system. A descriptive and comparative analysis was performed using SPSS software.
25 patients underwent SRP and 71 patients received SCAP. The mean follow-up was 24 months. The median PSA level before initial treatment was 8.3 (range 7-127) ng/ml. The success rates of SRP and SCAP were largely comparable (88% (22 patients) vs. 67.7% (48 patients), respectively, p = 0.216). The mean serum PSA levels at 12 months after salvage treatment were 1.2 ± 0.2 ng/mL vs. 0.25 ± 0.5 ng/mL, p > 0.05). During the follow-up period, only 3 (12%) patients in the SRP group had PSA recurrence compared with 21 patients (29.6%) in the SCAP group. The 5-year BRFS was similar (51,6% and 48,2%, p = 0,08) for SRP and SCAP respectively. The 5-year overall survival rate was 91.7%, and 89,7% (p = 0.669) and the 5-year cancer-specific survival was 91.7%, and 97,1% (p = 0.077), after SRP and SCAP respectively. No difference was found regarding the complications.
Both SRP and SCAP should be considered as valid treatment options for patients with local recurrence of PCa after radiotherapy. SCAP has a potentially lower risk of morbidity and acceptable intermediate-term oncological efficacy, but a longer follow up and a higher number of patients is ideally needed to draw any long-term conclusions regarding the oncological data.
本研究旨在比较挽救性前列腺根治切除术（SRP）与挽救性冷冻消融术（SCAP）治疗局部放射性复发性前列腺癌（PCa）患者的结局。
对欧洲泌尿外科学会技术分会（ESUT）的多中心回顾性数据库进行了分析。收集了接受挽救性治疗的放疗后局部复发性 PCa 患者的数据。描述了患者及其各自的疾病特征、围手术期并发症和肿瘤学结局。治疗成功率定义为 PSA 最低值 < 0.4ng/ml。根据改良 Clavien 系统对任何并发症进行分级。使用 SPSS 软件进行描述性和比较性分析。
25 例患者行 SRP，71 例患者行 SCAP。中位随访时间为 24 个月。初始治疗前中位 PSA 水平为 8.3（7-127）ng/ml。SRP 和 SCAP 的成功率大致相当（88%（22 例）与 67.7%（48 例），p = 0.216）。挽救性治疗后 12 个月的平均血清 PSA 水平分别为 1.2 ± 0.2ng/mL 和 0.25 ± 0.5ng/mL，p > 0.05）。在随访期间，SRP 组仅 3 例（12%）患者 PSA 复发，而 SCAP 组 21 例（29.6%）患者 PSA 复发。SRP 和 SCAP 的 5 年 BRFS 分别为 51.6%和 48.2%（p = 0.08）。5 年总生存率分别为 91.7%和 89.7%（p = 0.669），5 年癌症特异性生存率分别为 91.7%和 97.1%（p = 0.077）。两组并发症无差异。
SRP 和 SCAP 均可作为放疗后局部复发 PCa 患者的有效治疗选择。SCAP 的发病率潜在较低，中期肿瘤学疗效可接受，但需要更长的随访和更多的患者，才能对肿瘤学数据得出任何长期结论。
