高能聚焦超音波、冷凍治療、根除性攝護腺切除手術和體外放射治療作為
攝護腺癌救援性治療之討論
張賀翔、江博暉
高雄長庚紀念醫院泌尿科
Salvage treatment with high intensity focused ultrasound, cryotherapy, radical prostatectomy or radiotherapy after primary treatment of prostate cancer
Chang Ho Hsiang, Chiang Po Hui
Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
Purpose:
Radical prostatectomy (RP), radiotherapy, cryoablation or high intensity focused ultrasound (HIFU) plays a primary treatment of prostate cancer. However, there are 15-50 % patients suffering from biochemical failure after either primary treatment.
Materials and Methods:
HIFU, cryoablation or external beam radiotherapy (EBRT) has been used as a salvage role for these patients. We retrospectively review the treatment outcome of salvage EBRT for 42 prostate cancer patients after RP and 37 patients after HIFU with biochemical failure at our institute. Besides, patients after EBRT with biochemical failure receiving salvage HIFU or cryoablation will also be presented.
Results:
The biochemical failure rate after salvage EBRT was 14.3% in the RP group and 18.9% in the HIFU group, respectively (p=0.58). The complication rate of radiation proctitis was low (all grade 1) in both groups (2.4% and 5.4%in RP and HIFU group, respectively). No patient has radiation cystitis. However, 9(24.3%) patients in the HIFU group versus 3 (7.1%) patients experienced statistically significantly higher incidence rate of urethral stricture after salvage EBRT (p=0.03). HIFU or cryoablation serves as a salvage treatment after EBRT results in a feasible biochemical free survival at a price of high morbidity.
Conclusion:
All salvage treatment modalities (HIFU, cryoablation or EBRT) can achieve feasible cancer control rate. However, salvage treatment after EBRT seems to have a higher morbidity.