The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment (n= 3240, 84%). Other first-line treatments included HIFU (n= 338, 9%), electroporation (n= 59, 2%), proton beam therapy (n= 54, 1.5%), cryotherapy (n= 34, 1%), focal vascular targeted photodynamic therapy (n= 22, 0.6%), and transurethral ultrasound ablation (n= 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.
本研究旨在系统评价挽救性根治性前列腺切除术（sRP）治疗复发性前列腺癌的肿瘤学和功能学结局的现有证据。我们于2022年9月期间，遵循系统评价和荟萃分析优先报告条目（PRISMA）指南，在PubMed、Science Direct、Scopus和Embase数据库中进行系统文献检索。共纳入55项研究（3836例患者）符合筛选标准。绝大多数纳入患者以放射治疗（包括近距离放射治疗）作为一线治疗（n=3240，84%）。其他一线治疗包括高强度聚焦超声（HIFU）（n=338，9%）、不可逆电穿孔（n=59，2%）、质子束治疗（n=54，1.5%）、冷冻治疗（n=34，1%）、局部血管靶向光动力疗法（n=22，0.6%）以及经尿道超声消融（n=19，0.5%）。复发时术前PSA中位数范围为1.5至14.4 ng/mL。手术方式中，开放手术2300例（60%），机器人辅助手术1465例（38%），腹腔镜手术71例（2%）。自2019年以来，机器人手术相较于传统手术呈现明显增长趋势（分别为1245例与525例）。中位手术时间和术中失血量分别为80至297分钟和75至914毫升。2587例（79%）患者同时进行了淋巴结清扫。总体并发症发生率为34%，其中大部分为Clavien I级或II级并发症。Clavien ≥ 3级并发症发生率为0%至64%。792例（32%）患者出现手术切缘阳性。中位随访时间为4.6至94个月。sRP术后12个月、22个月和60个月的生化复发率分别为8%至51.5%、0%至66%以及48%至59%。5年肿瘤特异性生存率和总生存率分别为13.4%至98%和62%至100%。52.1%的患者术后保持了尿控功能。sRP显示出可接受的肿瘤学结局。这些sRP术后结果受多种因素影响，其中最重要的是包括影像学在内的治疗前评估，特别是随着多参数磁共振成像（mpMRI）和代谢成像技术的发展。我们的结果表明，对于经过选择的患者，sRP可被视为一种合适的治疗选择，但现有证据等级仍然较低。
Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU)
肿瘤(癌症)患者之家