放射治疗与聚焦治疗后挽救性机器人根治性前列腺切除术的结果：初始治疗方式重要吗？
The outcomes of salvage robotic radical prostatectomy following radiation versus focal therapy: Does the primary treatment modality matter?
作者信息
Ghoreifi Alireza, Ramacciotti Lorenzo Storino, Kaneko Masatomo, Medina Luis G, Cacciamani Giovanni E, Konganige Shiran, Aron Manju, Sadeghi Sarmad, Jadvar Hossein, Djaladat Hooman, Sotelo Rene, Desai Mihir M, Gill Inderbir S, Aron Monish, Abreu Andre Luis
机构信息
USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine University of Southern California Los Angeles California USA.
Center for Image-Guided Surgery, Focal Therapy and Artificial Intelligence for Prostate Cancer, Keck School of Medicine University of Southern California Los Angeles California USA.
出版信息
BJUI Compass. 2025 May 1;6(5):e70019. doi: 10.1002/bco2.70019. eCollection 2025 May.
OBJECTIVES
We aim to compare salvage robotic radical prostatectomy (sRRP) for recurrent prostate cancer (PCa) after primary radiation (RT) versus focal therapy (FT).
MATERIALS AND METHODS
Patients who underwent sRRP following primary local therapy for PCa were identified. Perioperative findings and functional/oncologic outcomes were compared in RT versus FT groups.
RESULTS
Overall, 112 patients were included, with 84 receiving RT and 28 FT as primary treatment. Median age and PSA were 68 years and 5.4 ng/mL, respectively. There was one rectal injury in the RT group. The overall 90-day complications were significantly higher in RT group (33% vs. 11%, = 0.03). On multivariable analysis, history of RT and prolonged operative time were associated with a higher rate of 90-day complications. The 6- and 12-month continence rates were higher in FT group (50% vs. 20%, = 0.02 and 69% vs. 33%, = 0.03). Potency at 12 months was better preserved in FT group (46% vs. 12%, = 0.01). On final sRRP pathology, the rates of grade group ≥ 4 (51% vs. 36%, = 0.2), pT3 (69% vs. 75%, = 0.6), positive nodes (30% vs. 18%, = 0.2) and positive margins (33% vs. 39%, = 0.5) were similar for RT versus FT, respectively. The 3-year biochemical recurrence-free survival was 86% for RT versus 94% for FT ( = 0.6). sRRP for recurrent PCa after FT is associated with lower complications and higher urinary continence and potency rates than patients who received primary RT.
目的
我们旨在比较针对原发性放疗（RT）或聚焦治疗（FT）后复发前列腺癌（PCa）的挽救性机器人根治性前列腺切除术（sRRP）。
材料与方法
确定接受PCa原发性局部治疗后行sRRP的患者。比较RT组和FT组的围手术期发现以及功能/肿瘤学结果。
结果
总体而言，纳入112例患者，其中84例接受RT作为主要治疗，28例接受FT作为主要治疗。中位年龄和前列腺特异性抗原（PSA）分别为68岁和5.4 ng/mL。RT组发生1例直肠损伤。RT组90天总体并发症显著更高（33%对11%，P = 0.03）。多变量分析显示，RT病史和手术时间延长与90天并发症发生率较高相关。FT组6个月和12个月的控尿率更高（50%对20%，P = 0.02；69%对33%，P = 0.03）。FT组12个月时性功能保留更好（46%对12%，P = 0.01）。在最终的sRRP病理检查中，RT组和FT组的≥4级分级组（51%对36%，P = 0.2）、pT3（69%对75%，P = 0.6）、阳性淋巴结（30%对18%，P = 0.2）和切缘阳性（33%对39%，P = 0.5）率分别相似。RT组3年无生化复发生存率为86%，FT组为94%（P = 0.6）。与接受原发性RT的患者相比，FT后复发PCa行sRRP的并发症更低，尿控率和性功能保留率更高。
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