達文西機器手臂輔助攝護腺根除術後手術邊緣陽性之男性提供早期輔助治療與積極監控的預後比較

陳昱廷、劉忠一

林口長庚紀念醫院 外科部泌尿科

Prognosis Comparison Between Adjuvant or Salvage Therapy vs Observation in Men with Positive Surgical Margin After Robotic-Assisted Radical Prostatectomy

Yu-Ting Chen, Chung-Yi Liu

Division of Urology, Department of Surgery, LinKou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Purpose: Positive surgical margin (PSM) in radical prostatectomy (RP) specimens for the treatment of localized prostate cancer (PCa) vary widely from 11% to 50%. The role of adjuvant radiotherapy (ART) or hormonal therapy (HT) in the management of positive surgical margin following radical prostatectomy for low-grade prostate cancer has remained controversial. We investigated our experience of metastasis-free and overall survival between adjuvant therapy, salvage therapy or active surveillance in PSM groups after robotic-assisted radical prostatectomy (RARP).

Materials and Methods: A total of 461 patients with prostate cancer (PCa) who underwent robotic-assisted radical prostatectomy (RARP) between December 2006 and June 2014. Patients with positive surgical margin (PSM) (N=78) were extracted. Patients have been followed up to March 2020. Adjuvant therapy was defined as having received either radiotherapy (RT) or hormonal therapy (HT) within 6 months after surgery. Biochemical failure was defined as a rise in PSA levels above 0.2 ng/mL. Salvage therapy defined as RT and/or HT arranged for biochemical recurrence (BCR) patients during out-patient clinic follow-up.

Results: No significant differences in age or preoperative PSA levels were observed after stratification into the adjuvant and observation groups. Eighteen patients (23.1%) received ART, primarily because their PSA levels did not fall below 0.2 ng/mL after RARP. Another 60 patients were requested to receive active surveillance, of which 28 (46.7%) received salvage therapy with RT/HT due to BCR detection (PSA rebound to > 0.2 ng/mL). There is no significant difference between adjuvant therapy and observation groups in the incidence of BCR (p=0.457), local recurrence, metastasis or cancer-specific mortality.

Conclusions: We found that early post-RARP adjuvant therapy might not offer a significant benefit compared to active surveillance in PSA progression, local recurrence, metastasis-free survival, or cancer-specific mortality. Salvage therapy may also be withheld until a rebound of PSA level is detected among the observation group. Thus, post-RARP PSM treatment strategies should be individualized after the risks and benefits have been assessed.