Role of salvage radical prostatectomy for recurrent prostate cancer after radiation therapy
Role of salvage radical prostatectomy for recurrent prostate cancer after radiation therapy
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DOI：
10.1200/jco.2005.03.1468
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发表时间：
2005-11-10
影响因子：
45.3
通讯作者：
Eastham, JA
中科院分区：
文献类型：
--
作者：
Stephenson, AJ;Eastham, JA
放射治疗后孤立性局部复发的前列腺癌患者有可能通过挽救性根治性前列腺切除术（BP）治愈其疾病。补救性RP的分期特异性5年癌症控制率与标准RP相似。然而，由于缺乏具有足够敏感性和特异性的诊断测试，无法在早期发现局部复发，同时又适合局部挽救治疗，因此无法有效地对放射复发疾病患者实施挽救治疗。根据目前美国放射学和肿瘤学治疗学会的定义，生化复发是指大多数患者的局部疾病已经发展到晚期，无法进行成功的局部挽救性治疗。当在前列腺特异性抗原水平为10 ng/mL或更低的情况下进行补救性RP时，估计70%的患者在5年内无疾病。随着更好的患者选择和技术改进，与救助性RP相关的发病率已大大提高。尿失禁和吻合口狭窄的发生率是可以接受的，尽管三分之一的患者会出现这些并发症。补救性冷冻治疗是补救性RP的一种微创替代方法，但癌症控制率似乎较低，并且在降低发病率方面没有明显优于补救性RIP。放射治疗后局部复发的患者转移进展和癌症特异性死亡率的风险增加。目前，救助性RP是这些患者唯一的治疗选择。补救性RP可能有利于改变放射治疗后生化复发的自然史，但它必须在疾病复发过程的早期建立才能有效。
Patients with isolated local recurrence of prostate cancer after radiation therapy may potentially be cured of their disease by salvage radical prostatectomy (BP). The stage-specific 5-year cancer-control rates of salvage RP resemble those of standard RP. However, the ability to effectively administer salvage treatment to patients with radiorecurrent disease is compromised by the lack of diagnostic tests with sufficient sensitivity and specificity to detect local recurrence at an early stage while it is amenable to local salvage therapy. By the time biochemical recurrence is declared using the current American Society for Therapeutic Radiology and Oncology definition, the majority of patients have advanced local disease, precluding successful local salvage therapy. When salvage RP is performed at prostate-specific antigen levels of 10 ng/mL or less, an estimated 70% of patients are free of disease at 5 years. With better patient selection and technical modifications, the morbidity associated with salvage RP has improved substantially. Rates of urinary incontinence and anastomotic stricture are acceptable, although one third of patients will experience these complications. Salvage cryotherapy is a minimally invasive alternative to salvage RP, but cancer-control rates appear to be inferior and it does not provide a clear advantage over salvage RIP in terms of reduced morbidity. Patients with local recurrence after radiation therapy are at increased risk of metastatic progression and cancer-specific mortality. Currently, salvage RP represents the only curative treatment option for these patients. Salvage RP may favorably alter the natural history of biochemical recurrence after radiation therapy, but it must be instituted early in the course of recurrent disease to be effective.