Abstract: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, rec… Show more
“…The definition of BCR after SRP varies depending on the institution, but may be PSA >0.12 [39], >0.2 [6,37,40,41,42,43,44,45,46], or >0.4 ng/ml [32,47,48]. The reported BCR-free survival probability ranges between 28 and 93%.…”
Section: Salvage Radical Prostatectomymentioning
confidence: 99%
“…Because the BCR-free survival definition depends on the PSA nadir, it is also a time-dependent variable, and by plotting the reported BCR-free rates with the follow-up lengths of different series, a decreasing tendency can be observed (Spearman's rank correlation, 2-sided p = 0.05), which is clearly more significant (R 2 = 58.5 vs. 15.7%, respectively) if only series with >40 patients are considered (fig. 1) [8,19,37,41,42,43,45]. …”
Section: Salvage Radical Prostatectomymentioning
confidence: 99%
“…2) [8,37,41,43,45,47,49]. The series published before 1995 had fewer patients than those published after 1998 (mean 27.8 vs. 62.7, not considering the series by Chade et al [19] for the previously mentioned reasons; t test: p = 0.047), and the rate of OCD was clearly higher, thus confirming the migration of patients toward lower stages (30.75 vs. 47%; t test p = 0.02).…”
Background: Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. Objective: The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. Methods: A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. Results: Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. Conclusions: Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.
“…The definition of BCR after SRP varies depending on the institution, but may be PSA >0.12 [39], >0.2 [6,37,40,41,42,43,44,45,46], or >0.4 ng/ml [32,47,48]. The reported BCR-free survival probability ranges between 28 and 93%.…”
Section: Salvage Radical Prostatectomymentioning
confidence: 99%
“…Because the BCR-free survival definition depends on the PSA nadir, it is also a time-dependent variable, and by plotting the reported BCR-free rates with the follow-up lengths of different series, a decreasing tendency can be observed (Spearman's rank correlation, 2-sided p = 0.05), which is clearly more significant (R 2 = 58.5 vs. 15.7%, respectively) if only series with >40 patients are considered (fig. 1) [8,19,37,41,42,43,45]. …”
Section: Salvage Radical Prostatectomymentioning
confidence: 99%
“…2) [8,37,41,43,45,47,49]. The series published before 1995 had fewer patients than those published after 1998 (mean 27.8 vs. 62.7, not considering the series by Chade et al [19] for the previously mentioned reasons; t test: p = 0.047), and the rate of OCD was clearly higher, thus confirming the migration of patients toward lower stages (30.75 vs. 47%; t test p = 0.02).…”
Background: Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. Objective: The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. Methods: A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. Results: Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. Conclusions: Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.
“…25 Differently from RT, surgical treatment is cytoreductive and does not have potential to induce cellular mutations that could lead to resistance or increase tumor kinetics. Patients who fail RT are very rarely operated as salvage treatment because of poor functional outcomes, 26 in contrast to patients who underwent salvage RT and endure much better results. In clinical jargon by many practitioners, to start treatment for LAPC by surgery is "to have a card up your sleeve" owing to the possibility of indicating salvage RT in case of BCR.…”
Section: Radical Prostatectomy Vs Radiotherapymentioning
“…[30] Nearly half of the patients within this group ultimately elect to undergo AUS implantation. [31][32][33][34] Patient anatomy has also been shown to influence the development of incontinence following prostatectomy. For example, the presence of an anatomic stricture [35,36] or larger prostate volume [37] is associated with higher rates of incontinence.…”
Urinary incontinence after prostatectomy or radiation is a devastating problem in men and remains the most feared complication following the treatment of localized prostate cancer. With an increasing number of radical prostatectomies performed globally for prostate cancer, the impact of urinary incontinence on quality of life assumes an even greater importance. With the advent of male sling procedures, more men are now seeking treatment for incontinence. Since the introduction of the artificial urinary sphincter almost four decades ago, several surgical procedures have emerged to manage post-prostatectomy incontinence, including the male sling for milder forms of incontinence. Several of the newer procedures have shown promise in the United States; many others have been developed and utilized in other parts of the world, though they have not yet gained FDA approval in the United States. The present review seeks to illuminate the etiology, evaluation, and management of post-prostatectomy incontinence. An effort has been made to provide an algorithm to clinicians for appropriate surgical management. The surgical techniques of commonly performed procedures and their outcomes are described.
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