達文西機械手臂輔助攝護腺根除術後生化復發患者接受救援性放射線治療與雄激素剝奪療法的比較性研究：單一醫學中心經驗

曾華緯¹、鄭宛妤¹、謝佳駤¹、曾文歆¹、李高漢¹、謝昆霖¹、劉建良^1、2、黃冠華¹

¹台南永康奇美醫院 外科部 泌尿科，

²台南永康奇美醫院 外科部 泌尿腫瘤科

Comparative Follow-up Study of Salvage Radiation Therapy versus Androgen-Deprivation Therapy for Localized Prostate Cancer with Biochemical Recurrence after Robotic-Assisted Radical Prostatectomy: A Single Center Experience

Hua-Wei Tseng¹, Wan-Yu Cheng¹, Chia-Chih Hsieh¹, Wen-Hsin Tseng¹, Kau-Han Lee¹,

Kun-Lin Hsieh¹, Chien-Liang Liu^1、2, Steven K. Huang¹

¹Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan,

²Division of Uro-oncology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Purpose: The salvage treatments for biochemical recurrence (BCR) include local external beam radiation therapy (RT) and systemic androgen-deprivation therapy (ADT). Current guidelines suggest salvage RT with or without ADT for patients with BCR. However, failure of primary salvage RT is often observed due to complications such as urinary incontinence, especially in patients who have undergone Robotic-Assisted Radical Prostatectomy (RaRP). Therefore, physicians often prefer salvage ADT alone when managing BCR post-RaRP due to the lower risk of complications. Our study aimed to evaluate the impact of salvage ADT alone versus salvage RT with or without ADT.

Materials and Methods: We reviewed patients of high risk and very high risk group who underwent Robotic-Assisted Radical Prostatectomy (RaRP) at our institution between 2017 and 2022 and subsequently developed biochemical recurrence (BCR). After excluding patients whose nadir prostate-specific antigen (PSA) was higher than 0.2 ng/mL and those who received neoadjuvant or adjuvant therapy, the remaining 26 patients comprised the cohort for this study. Salvage radiation therapy (RT) and androgen-deprivation therapy (ADT) were administered to 11 and 15 patients, respectively. In cases where salvage RT failed, subsequent ADT was initiated. The starting point of this study was the onset of BCR, and the endpoint was the development of castration-resistant prostate cancer (CRPC).

Results: During the mean follow-up period of 3.9 years after BCR, CRPC was observed in 2 patients who were administered ADT. There was no difference found in PSA level at RaRP (p=0.74), Nadir PSA (p=0.43), PSA level at BCR (p=0.14), and PSA-doubling time at BCR (p=0.55) between the RT and ADT groups. We observed no CRPC in the RT±ADT group. Kaplan–Meier curves demonstrated no significant difference in CRPC-free survival between the RT and ADT groups (5-year CRPC-free survival: 100.0% vs. 87%, p=0.317).

Conclusions: This study suggests no significant difference in CRPC-free survival between salvage ADT alone and salvage RT with or without ADT in patients with BCR post-RaRP. However, the study is limited by a relatively short follow-up period of 3.9 years and a small sample size of 26 patients. Future research with larger cohorts and longer follow-up periods is necessary to confirm these findings and better understand the long-term outcomes of these treatment strategies.