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

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, 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.

Salvage Radical Prostatectomy after External Beam Radiation Therapy: A Systematic Review of Current Approaches

“…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%.…”

“…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]. …”

“…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).…”

Radical Prostatectomy for Locally Advanced Prostate Cancer: Current Status

“…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.…”

Post-prostatectomy incontinence: Etiology, evaluation, and management

“…[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.…”