Salvage radical prostatectomy: an alternative treatment for local recurrence of radioresistant cancer

Dall’Oglio, Marcos F.; Barreto, Francualdo; Paranhos, Mario; Nesrallah, Adriano; Nesrallah, Luciano J.; Srougi, Miguel

doi:10.1590/s1677-55382006000500007

Cited by 9 publications

(8 citation statements)

References 22 publications

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“…The surgery is tactically and technically similar to primary radical retropubic prostatectomy (5,16). Also, laparoscopic salvage radical prostatectomy has been reported as a surgical approach (19).…”

Section: Commentsmentioning

confidence: 98%

“…The intraoperative rectal injury rates were considered insignificant, since it occurred in only one case. The rate of rectal injury reported in the literature was between 0% and 19% (3)(4)(5)8).…”

Section: Commentsmentioning

confidence: 99%

“…Despite being employed for more than three decades, currently SRP is only offered to 25% of eligible patients who potentially are most likely to benefit from such therapy (4)(5)(6). The main reasons for this low rate of use are the technical challenges during the procedure and the increased risk of complications, such as urinary incontinence or obstruction, erectile dysfunction, and rectal lesions (2,5).…”

Section: Introductionmentioning

confidence: 99%

“…The main reasons for this low rate of use are the technical challenges during the procedure and the increased risk of complications, such as urinary incontinence or obstruction, erectile dysfunction, and rectal lesions (2,5). The aim of our study was to critically evaluate the role of radical prostatectomy in saving patients suffering from confirmed recurrence of prostate cancer restricted to the gland after treatment with conventional RT.…”

Section: Introductionmentioning

confidence: 99%

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Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

Seabra¹,

Faria²,

Dauster³

et al. 2009

Int. braz j urol.

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Purpose: To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa). Materials and Methods: From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year. Results: Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy , the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months. Conclusions: SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.

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Section: Commentsmentioning

confidence: 98%

Section: Commentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

Seabra¹,

Faria²,

Dauster³

et al. 2009

Int. braz j urol.

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“…57 The recently published complication rates of salvage radical prostatectomy show rectal injury rates of 0-4%, incontinence rates of 17-55% and anastomotic strictures in 0-41% of patients. [57][58][59][60][61][62][63][64][65][66] In modern cryotherapy series, the reported rates of complications were rectal fistula in 0-1%, incontinence in 13-17% and perineal pain in 4-5.6%. 67,68 The age and performance status of the salvage prostatectomy and 39 32 Not reported 3 months 50% PSA nadir p0.2 ng ml Murat et al 40 72 80% 39 months 44% (5 years) Nadir+2 Seo et al 41 30 NA 12 months 56.7% Definition NA Mallik et al 42 68 NA 6 months 54.4% PSA X0.5…”

Section: Complications/toxicity Of Salvage Hifumentioning

confidence: 99%

Salvage HIFU for recurrent prostate cancer after radiotherapy

Chalasani

Martínez

Lim

et al. 2008

Prostate Cancer Prostatic Dis

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Recurrent disease following primary radiotherapy for localized prostate cancer is a common problem, occurring in up to 46% of patients. For these patients, therapeutic options include salvage prostatectomy, salvage cryotherapy, salvage high-intensity focused ultrasound (HIFU), hormonal therapy or observation. This review will focus on the emerging evidence for salvage HIFU. There are no randomized or prospective studies in this area. Efficacy results of 17-57% have been reported from retrospective case series, with reported toxicity including rectal fistula in 0-16%, and incontinence in 10-50%. The ideal patient, while yet to be clearly defined, should have preradiotherapy low or intermediate risk disease. Salvage HIFU appears most appropriate for those patients with histologically proven local recurrence only, with a life expectancy of at least 5 years and with some medical comorbidities rendering them not ideal for salvage prostatectomy.

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Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate‐specific antigen failure

Nguyen

D’Amico

Lee

et al. 2007

Cancer

221

138

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Among men who experience prostate-specific antigen (PSA) failure after external beam radiation or brachytherapy (RT), many will harbor occult micrometastases; however, a significant minority will have a true local-only failure and, thus, potentially may benefit from a salvage local therapy. Those most likely to have a local-only failure initially have low-risk disease (PSA <10 ng/mL, Gleason score 6, clinical T1c or T2a tumor status), pretreatment PSA velocity <2.0 ng/mL per year at the time of initial presentation, interval to PSA failure >3 years, PSA doubling time >12 months, negative bone scan and pelvic imaging, and positive rebiopsy. In addition, men with presalvage PSA levels >10 ng/mL, presalvage T3/ T4 disease, or presalvage Gleason scores 7 on a rebiopsy sample without significant RT effects are unlikely to be cured by salvage local therapy. Based on a review of all series of post-RT salvage prostatectomy, cryosurgery, and brachytherapy published in English since 1990, morbidity can be substantial. Although urinary incontinence appeared to be greater after salvage prostatectomy (41%) or cryosurgery (36%) than after brachytherapy (6%), patients who received salvage brachytherapy faced a 17% risk of grade 3 or 4 genitourinary complications and a fistula risk that averaged 3.4% across all series. From this review, the authors concluded that prospective randomized studies are needed to determine the relative efficacy of the 3 major local salvage modalities and that additional research is needed to identify factors associated with an increased risk of significant complications to improve patient selection and to augment the benefit/risk ratio associated with attempts to cure local-only recurrences after radiation therapy.

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Salvage radical prostatectomy: an alternative treatment for local recurrence of radioresistant cancer

Abstract: Salvage radical prostatectomy is a safe and effective alternative for the treatment of locally recurrent prostate cancer after radiotherapy and brachytherapy.

Cited by 9 publications

References 22 publications

Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

Salvage HIFU for recurrent prostate cancer after radiotherapy

Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate‐specific antigen failure

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