Lucas Seiti Takemura MD , Pedro Henrique Peixoto Costa MD , Oliver Rojas Claros MD , Rafael Rocha Tourinho-Barbosa MD, MSc , Saulo Borborema Teles MD , Rafael Sanchez-Salas MD, PhD , Bruno Nahar MD , Ruben Olivares MD , Erik Montagna MSc, PhD , Gustavo Caserta Lemos MD, PhD , Bianca Bianco MSc, PhD , Arie Carneiro MD, PhD
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Eligible studies included patients with clinically localised PCa initially treated with FT, who experienced relapse during surveillance and subsequently underwent salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT) or salvage focal therapy (sFT). The primary endpoint was the biochemical recurrence rate post-salvage treatment. The secondary endpoints were functional outcomes, including urinary incontinence and erectile dysfunction rates.</div></div><div><h3>Results</h3><div>In 26 retrospective studies including 990 patients, the overall pooled biochemical recurrence rate postsalvage treatment was 26%. The subgroup analysis revealed a biochemical recurrence rate of 20%, 22%, and 42% after sRP, sEBRT, and sFT, respectively. The overall pooled rate of urinary incontinence was 20%. Salvage FT had the lowest prevalence of urinary incontinence, followed by sRP and sEBRT. The overall pooled rate of erectile dysfunction was 43%. Salvage RP had the highest prevalence of erectile dysfunction, followed by sFT and sEBRT. Substantial heterogeneity was observed among the studies, primarily due to different sample sizes. Meta-regression analysis revealed no to low contributions of salvage treatment modalities, extent of ablation, age, prostatic specific antigen level before salvage treatment, proportion of patients with Gleason score ≥7 at recurrence, and time between the primary and salvage therapies to heterogeneity.</div></div><div><h3>Conclusion</h3><div>Salvage local treatment for recurrent PCa after FT is feasible, and it provides acceptable oncological and functional outcomes. 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引用次数: 0
摘要
目的评估挽救性局部治疗在治疗 FT 后复发 PCa 中的作用，重点关注肿瘤学和功能性结果：方法：按照PRISMA框架进行系统回顾和荟萃分析。我们使用 PubMed/MEDLINE 和 EMBASE 数据库进行了全面的文献检索，直至 2023 年 7 月。符合条件的研究包括最初接受前列腺癌根治术（FT）治疗的临床局部PCa患者，这些患者在监测期间复发，随后接受了挽救性前列腺癌根治术（sRP）、挽救性体外放射治疗（sEBRT）或挽救性病灶治疗（sFT）。主要终点是挽救治疗后的生化复发率。次要终点是功能性结果，包括尿失禁率和勃起功能障碍率：结果：在26项回顾性研究（包括990名患者）中，总的生化复发率为26%。亚组分析显示，sRP、sEBRT 和 sFT 治疗后的生化复发率分别为 20%、22% 和 42%。尿失禁的总体汇总率为20%。抢救性 FT 的尿失禁发生率最低，其次是 sRP 和 sEBRT。勃起功能障碍的总合发生率为43%。抢救性 RP 的勃起功能障碍发生率最高，其次是 sFT 和 sEBRT。研究之间存在很大的异质性，主要是由于样本量不同。元回归分析显示，挽救治疗方式、消融范围、年龄、挽救治疗前前列腺特异抗原水平、复发时Gleason评分≥7分的患者比例以及主要治疗与挽救治疗之间的时间对异质性的影响不大：结论：对 FT 后复发的 PCa 进行局部挽救治疗是可行的，而且能提供可接受的肿瘤学和功能结果。在所有治疗方式中，sRP 和 sEBRT 的生化复发率似乎最低，而 sFT 与功能预后的改善相关。
Salvage local treatment for recurrent prostate cancer after focal therapy: A systematic review and meta-analysis
Objectives
To evaluate the role of salvage local treatment in managing recurrent PCa following FT, focusing on oncological and functional outcomes.
Methods
A systematic review and meta-analysis were performed following the PRISMA framework. A comprehensive literature search using the PubMed/MEDLINE and EMBASE databases was performed until July 2023. Eligible studies included patients with clinically localised PCa initially treated with FT, who experienced relapse during surveillance and subsequently underwent salvage radical prostatectomy (sRP), salvage external beam radiation therapy (sEBRT) or salvage focal therapy (sFT). The primary endpoint was the biochemical recurrence rate post-salvage treatment. The secondary endpoints were functional outcomes, including urinary incontinence and erectile dysfunction rates.
Results
In 26 retrospective studies including 990 patients, the overall pooled biochemical recurrence rate postsalvage treatment was 26%. The subgroup analysis revealed a biochemical recurrence rate of 20%, 22%, and 42% after sRP, sEBRT, and sFT, respectively. The overall pooled rate of urinary incontinence was 20%. Salvage FT had the lowest prevalence of urinary incontinence, followed by sRP and sEBRT. The overall pooled rate of erectile dysfunction was 43%. Salvage RP had the highest prevalence of erectile dysfunction, followed by sFT and sEBRT. Substantial heterogeneity was observed among the studies, primarily due to different sample sizes. Meta-regression analysis revealed no to low contributions of salvage treatment modalities, extent of ablation, age, prostatic specific antigen level before salvage treatment, proportion of patients with Gleason score ≥7 at recurrence, and time between the primary and salvage therapies to heterogeneity.
Conclusion
Salvage local treatment for recurrent PCa after FT is feasible, and it provides acceptable oncological and functional outcomes. Among all treatment modalities, sRP and sEBRT appeared to have the lowest biochemical recurrence rates, whereas sFT was associated with improved functional outcomes.
期刊介绍：
Urologic Oncology: Seminars and Original Investigations is the official journal of the Society of Urologic Oncology. The journal publishes practical, timely, and relevant clinical and basic science research articles which address any aspect of urologic oncology. Each issue comprises original research, news and topics, survey articles providing short commentaries on other important articles in the urologic oncology literature, and reviews including an in-depth Seminar examining a specific clinical dilemma. The journal periodically publishes supplement issues devoted to areas of current interest to the urologic oncology community. Articles published are of interest to researchers and the clinicians involved in the practice of urologic oncology including urologists, oncologists, and radiologists.
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