Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review

Abstract

Purpose: To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer. Methods: This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study. Results: The rates of severe urinary incontinence ranged from 28–88%, 4.5–42%, 0–6.5%, 2.4–8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5–3.4, 3.5–12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate. Conclusions: local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process.

Early Experience with Salvage Robotic-Assisted Radical Prostatectomy in Proton Beam Radiotherapy Failures

“…Severe UI rates were estimated as 23% on average in all articles about salvage surgery, while some studies have even estimated it as 85%. 5 ,24, 25 Moreover, urinary continence was evaluated as 21-90% on longer follow ups after salvage surgery. As surgical techniques improve, and patient selection increases, these complications have been seen less frequently in recent studies.…”

“…On the other hand, salvage therapies lack an ideal treatment protocol due to the shortage of high-quality data, undesirable side effects of treatments, and inadequate contribution to survival rates. 4 , 5 …”

Pathological Significance of Macrophages in Erectile Dysfunction Including Peyronie’s Disease

“…Although various factors have been reported to be etiological factors of neurogenic ED, major surgery and radiotherapy of the pelvis/retroperitoneum are well-known causes of neurogenic ED [ 37 ]. In fact, ED is one of the most common sequelae of radical prostatectomy and radiation therapy for prostate cancer [ 10 , 12 ]. With the development of new surgical techniques and devices, including robot-assisted radical prostatectomy with nerve-sparing techniques, modern external beam radiotherapy, brachytherapy, rehabilitation, and treatment options for ED, the frequency and degree of prostatectomy-induced ED is decreasing [ 12 , 38 , 39 , 40 ].…”

“…However, PDE5 inhibitors are effective only for a subgroup of ED patients [ 7 ]. Apart from molecular mechanisms that are centered on cGMP, many other factors have also been recognized to cause ED, such as vascular disorders, trauma- or operation-induced nerve injury, and inflammatory disease of the penis [ 8 , 9 , 10 , 11 , 12 ]. Therefore, novel therapeutic agents for ED need to be developed, and more detailed and wider knowledge is necessary to address this issue.…”

Diagnosis and Treatment of Prostate Adenocarcinoma

“…Abufaraj et al [9] performed a systematic review of the functional outcomes after local salvage therapies for patients with radiation-recurrent prostate cancer. They found that the rates of severe incontinence and erectile dysfunction were high after local salvage therapies, such as radical prostatectomy, HIFU, cryotherapy and brachytherapy for radiation-recurrent disease.…”