Rogers E, Ohori M, Kassabian V S, Wheeler T M, Scardino P T
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
J Urol. 1995 Jan;153(1):104-10. doi: 10.1097/00005392-199501000-00037.
We reviewed our experience with salvage radical prostatectomy for locally recurrent cancer in 40 patients to assess the current complication rate and the results using prostate specific antigen (PSA) as an indicator of treatment outcome and to identify better criteria for the selection of appropriate candidates for this operation. Most recurrent cancers were detected by digital rectal examination (26 patients) or increasing serum PSA levels (10). The operation was technically challenging, with 6 rectal injuries (15%), 2 requiring temporary colostomy. Serious technical complications were more common (31%) among the 29 patients who underwent pelvic lymphadenectomy at the time of initial radiotherapy than among the 11 treated with external irradiation alone (9%). Urinary incontinence persisted in 18 of 31 evaluable patients (58%) and was successfully corrected with an artificial urinary sphincter in 9. A total of 21 patients (54%) had pathologically advanced disease (seminal vesicle invasion and/or lymph node metastases). Preoperative PSA levels but not clinical stage or biopsy grade correlated with pathological stage (p < 0.03). If the PSA was less than 10 ng./ml. only 15% of the patients had an advanced pathological stage, compared to 86% if the PSA was 10 or more. After 2 to 97 months (mean 39) 2 patients died of metastatic prostatic cancer, 5 had distant metastases and none had symptomatic local recurrence. At 5 years the actuarial nonprogression rate measured by PSA was 55 +/- 20%. The only pretreatment factor predictive of progression was the serum PSA level. If the PSA was less than 10 ng./ml. the actuarial rate of progression was significantly lower than if the PSA was greater than 10 (p < 0.05). The best results were in the subset of 18 patients with cancer confined to the prostate or immediate periprostatic tissue: 82% had no progression at 5 years. Within each of these pathological stages the results of salvage prostatectomy were similar to those for standard radical prostatectomy in patients with no prior irradiation. Although technically challenging, salvage prostatectomy provides excellent control of radio-recurrent cancer confined to the prostate or immediate periprostatic tissue and is best performed before the preoperative PSA level increases to greater than 10 to 20 ng./ml.
我们回顾了40例局部复发性癌症患者接受挽救性根治性前列腺切除术的经验，以评估当前的并发症发生率，并以前列腺特异性抗原（PSA）作为治疗效果指标来评估结果，同时确定更好的标准以选择适合该手术的患者。大多数复发性癌症通过直肠指检（26例患者）或血清PSA水平升高（10例）被发现。该手术在技术上具有挑战性，有6例直肠损伤（15%），其中2例需要临时结肠造口术。在初始放疗时接受盆腔淋巴结清扫术的29例患者中，严重技术并发症更为常见（31%），而仅接受外照射的11例患者中严重技术并发症发生率为9%。31例可评估患者中有18例（58%）持续存在尿失禁，其中9例通过人工尿道括约肌成功矫正。共有21例患者（54%）存在病理分期较晚的疾病（精囊侵犯和/或淋巴结转移）。术前PSA水平与病理分期相关（p < 0.03），而临床分期或活检分级与之无关。如果PSA低于10 ng/ml，只有15%的患者病理分期较晚，而如果PSA为10或更高，这一比例为86%。2至97个月（平均39个月）后，2例患者死于转移性前列腺癌，5例出现远处转移，无一例有症状性局部复发。5年时，以PSA衡量的精算无进展率为55±20%。唯一可预测进展的术前因素是血清PSA水平。如果PSA低于10 ng/ml，精算进展率显著低于PSA大于10时（p < 0.05）。18例癌症局限于前列腺或紧邻前列腺周围组织的患者亚组效果最佳：5年时82%无进展。在这些病理分期的每一期中，挽救性前列腺切除术的结果与未接受过放疗患者的标准根治性前列腺切除术结果相似。尽管在技术上具有挑战性，但挽救性前列腺切除术能很好地控制局限于前列腺或紧邻前列腺周围组织的放疗后复发性癌症，并且最好在术前PSA水平升高至大于10至20 ng/ml之前进行。
