Recurrencia local tras radioterapia o braquiterapia en cáncer de próstata: ¿qué hacer? Análisis retrospectivo comparativo entre prostatectomía radical y crioablación de rescate

IF 1.7 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2026-03-01 Epub Date: 2025-12-18 DOI:10.1016/j.acuro.2025.501914

C. Martínez Osorio , P. de Pablos-Rodríguez , N. Valdés Figueroa , M. Beamud Cortés , C. Gutiérrez Castañé , Á. Gómez-Ferrer Lozano , A. Wong Gutiérrez , Y. Murria Pérez , B. Sanvictor Beneito , A. Calatrava Fons , J. Patiño Aliaga , Á. García Cortés , J.A. López González , V. Rodríguez-Part , P. Pelechano Gómez , J.L. Casanova Ramón-Borja

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Abstract

Introduction and objective

Local recurrence after radiotherapy for prostate cancer poses a significant clinical challenge, and the lack of robust comparative evidence limits clear therapeutic guidance. This study aimed to assess oncological outcomes of salvage radical prostatectomy (SRP) versus salvage cryoablation (SCA) in patients with localized radio-recurrent disease.

Material and methods

A retrospective, single-centre cohort study was conducted including hormone-sensitive prostate cancer patients with local recurrence after external beam radiotherapy or brachytherapy, treated between 2007 and 2024. The primary endpoint was biochemical recurrence-free survival at 3 and 5 years. Secondary endpoints included additional treatment-free survival, metastasis-free survival, and recurrence predictors. Kaplan-Meier and multivariate logistic regression analyses were performed.

Results

A total of 56 patients were included: 32 treated with SRP and 24 with SCA. Median follow-up was significantly longer in the SCA group (98 vs. 46 months, p < 0.05). Biochemical recurrence-free survival at 3 and 5 years was 47 and 37% in the SCA group and 43 and 32% in the SRP group (p > 0.05). Five-year additional treatment-free survival was 40% (SCA) vs. 55% (SRP; p = 0.32), and metastasis-free survival was 85 (SCA) vs. 83% (SRP; p = 0.92). A Gleason score ≥ 8 at recurrence was independently associated with higher risk of recurrence (OR 7.7; 95% CI: 1.3-47; p = 0.02).

Conclusions

SRP and SCA showed similar oncological outcomes. Gleason ≥ 8 was the only factor related to poor outcomes. Given the low chance of cure after salvage therapies, SCA may be an adequate option in these patients.

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前列腺癌放疗或近距离治疗后局部复发：该怎么办？根治性前列腺切除术与挽救性冷冻切除的回顾性比较分析

前列腺癌放疗后局部复发是一个重大的临床挑战，缺乏有力的比较证据限制了明确的治疗指导。本研究旨在评估局部放射复发性疾病患者的补救性根治性前列腺切除术（SRP）与补救性冷冻消融（SCA）的肿瘤学结果。材料与方法回顾性、单中心队列研究，纳入2007年至2024年间接受外束放疗或近距离放疗后局部复发的激素敏感前列腺癌患者。主要终点是3年和5年的生化无复发生存率。次要终点包括额外的无治疗生存期、无转移生存期和复发预测指标。Kaplan-Meier和多元逻辑回归分析。结果共纳入56例患者：SRP组32例，SCA组24例。SCA组的中位随访时间明显更长（98个月对46个月，p < 0.05）。SCA组3年和5年无生化复发生存率分别为47%和37%，SRP组为43%和32% （p > 0.05）。5年额外无治疗生存率为40% (SCA) vs 55% (SRP; p = 0.32)，无转移生存率为85 (SCA) vs 83% （SRP; p = 0.92）。复发时Gleason评分≥8与较高的复发风险独立相关（OR 7.7; 95% CI: 1.3-47; p = 0.02）。结论ssrp与SCA具有相似的肿瘤预后。Gleason≥8是唯一与不良预后相关的因素。鉴于挽救性治疗后治愈的机会较低，SCA可能是这些患者的适当选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.