Pathological Characteristics of Prostate Cancer Recurrence After Radiation Therapy: Implications for Focal Salvage Therapy
Pathological Characteristics of Prostate Cancer Recurrence After Radiation Therapy: Implications for Focal Salvage Therapy
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DOI：
10.1016/j.juro.2012.02.2571
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发表时间：
2012-07-01
影响因子：
6.6
通讯作者：
Troncoso, Patricia
中科院分区：
文献类型：
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作者：
Leibovici, Dan;Chiong, Edmond;Troncoso, Patricia
目的：目前正在研究局灶性治疗作为原发性放射治疗后局部复发前列腺癌根治性前列腺切除术的替代方法。如果患者选择得当，局灶性治疗可以使肿瘤根除，而不会出现与补救性根治性前列腺切除术相关的并发症。我们描述在挽救根治性前列腺切除术标本中复发性前列腺癌的病理特征以及这些结果对局灶治疗的意义。材料和方法：我们收集了1993年至2008年间50例原发性放射治疗后复发并行补救性根治性前列腺切除术的患者的资料。术前前列腺特异性抗原低于10 ng/ml的患者49例（98%），活检Gleason评分低于7的患者18例（36%）。对残存的根治性前列腺切除术标本进行肿瘤的分区起源、部位和体积、Gleason评分和病理分期分析。结果：术前前列腺特异性抗原中位数为3.4 ng/ml。病理分期为T2的23例（46%）。17例（34%）患者根治性前列腺切除术Gleason评分为7分或以下，43例（86%）患者手术切缘为阴性。单一病灶33例（66%），双侧病灶37例（74%）。23例（46%）肿瘤累及尿道底端，37例（74%）肿瘤位于距尿道5.0 mm以内。中位肿瘤体积为1.27 cm(3)（范围0.05 ~ 12.96）。结论：前列腺癌放射治疗后复发多为双侧多发、多区累及。它通常是高级别的，体积大，靠近尿道。这些发现表明，在放疗失败后计划补救性局灶治疗将是困难的。
Purpose: Focal therapy is currently under investigation as an alternative to salvage radical prostatectomy for locally recurrent prostate cancer after primary radiation therapy. If patients can be selected properly, focal therapy could enable tumor eradication without the morbidity associated with salvage radical prostatectomy. We describe the pathological features of recurrent prostate cancer in salvage radical prostatectomy specimens and the implications of these results for focal therapy.Materials and Methods: We gathered data on 50 consecutive patients who had recurrence after primary radiation therapy and underwent salvage radical prostatectomy between 1993 and 2008. Preoperatively prostate specific antigen was less than 10 ng/ml in 49 patients (98%) and biopsy Gleason score was 7 or less in 18 (36%). Salvage radical prostatectomy specimens were analyzed for tumor zonal origin, site and volume, Gleason score and pathological stage.Results: Median preoperative prostate specific antigen was 3.4 ng/ml. Pathological stage was T2 in 23 patients (46%). The salvage radical prostatectomy Gleason score was 7 or less in 17 patients (34%) and surgical margins were negative in 43 (86%). A single cancer focus was found in 33 cases (66%) while there was bilateral involvement in 37 (74%). The base and apex were involved in 23 cases (46%) and 37 tumors (74%) were located within 5.0 mm of the urethra. Median tumor volume was 1.27 cm(3) (range 0.05 to 12.96).Conclusions: Prostate cancer recurrence after radiation therapy is often bilateral and involves multiple zones. It is often high grade, bulky and close to the urethra. These findings suggest that planning salvage focal therapy after radiation failure will be difficult.