In men who do not respond to initial radiation therapy, accurate knowledge of the site of cancer recurrence or persistence is necessary to understand treatment failure. We evaluated the pathologic characteristics of recurrent/persistent prostate cancer with tumor maps from the whole-mount slides of salvage radical prostatectomies performed between 2000 and 2014. Of 216 consecutive patients, detailed tumor maps were available for 77. Sixty-nine patients (90%) were found to have tumor in the apex, of which 46% occurred in the most apical 3 mm. Fifty-three patients (69%) had tumors at a distance of ≤5 mm from the urethra. Five patients had tumor directly involving the urethra, all of whom had urethral invasion at the apex. Seminal vesicle involvement was seen in 32 patients (42%), two of whom had tumor only in the seminal vesicles. Sixty-two patients (81%) had tumors in the distal apex, periurethral area, or seminal vesicles, that is, areas that are not routinely biopsied. Targeting these areas could improve the accuracy of biopsy when cancer recurrence is suspected.

Patient summary

When recurrence is suspected, clinicians should include biopsy of the distal apex, areas surrounding the urethra, and seminal vesicles. This information will help tailor successful salvage treatments.

中文翻译：

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放射治疗后前列腺癌复发的地形图：挽救性根治性前列腺切除术标本的详细定位研究

在对初始放射治疗无反应的男性中，必须准确了解癌症复发或持续的部位，才能了解治疗失败的原因。我们从2000年至2014年进行的抢救性根治性前列腺切除术的完整幻灯片中的肿瘤图，评估了复发/持续性前列腺癌的病理特征。在216例连续患者中，有77例患者可获得详细的肿瘤图。69例（90％） ）被发现在顶端有肿瘤，其中46％发生在最顶端的3 mm处。53名患者（69％）的肿瘤距尿道的距离小于等于5 mm。五名患者的肿瘤直接累及尿道，所有患者的尿道均侵犯尿道。精囊囊肿受累32例（42％），其中2例仅在精囊囊中有肿瘤。62例患者（81％）在远端，尿道旁区域或精囊（即未常规活检的区域）内有肿瘤。当怀疑癌症复发时，针对这些区域可以提高活检的准确性。

病人总结

当怀疑复发时，临床医生应进行远端根尖，尿道周围区域和精囊的活检。此信息将帮助定制成功的打捞处理。