Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy

Bianco, Fernando J.; Scardino, Peter T.; Stephenson, Andrew J.; DiBlasio, Christopher J.; Fearn, Paul; Eastham, James A.

doi:10.1016/j.ijrobp.2004.09.049

Cited by 189 publications

(144 citation statements)

References 15 publications

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“…Overall, rates of erectile dysfunction are high because of previous therapy, and in any case, nerve-sparing is compromised. Transient urine leaks may occur after surgery; bladder neck contractures are more frequent; and posterior urethral distraction and even rectal injuries with recto-urethral fistula development have been reported [40][41][42] . Because of such consequences, implantation of artificial urinary sphincters and inflatable penile prostheses produces better outcomes in patients with postoperative urinary incontinence or erectile dysfunction and should be part of any discussion about salvage rp.…”

Section: S30mentioning

confidence: 99%

“…Because of such consequences, implantation of artificial urinary sphincters and inflatable penile prostheses produces better outcomes in patients with postoperative urinary incontinence or erectile dysfunction and should be part of any discussion about salvage rp. The cancer-specific mortality after salvage rp has been reported to be 27% at 10 years and 40% at 15 years 42 . Therefore, in counselling such patients, rp is definitely possible, with acceptable oncologic control and positive margin rates of approximately 30%, but at a higher cost.…”

Section: S30mentioning

confidence: 99%

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Role of Surgery in High-Risk Localized Prostate Cancer

et al. 2010

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Men with high-risk localized prostate cancer (pca) remain a challenge for clinicians. Until recently, surgery was not the preferred approach, in part because risk of subclinical metastatic disease, elevated rates of positive surgical margins, absence of randomized studies, and suboptimal cancer control did not justify the morbidity of surgery. No randomized data comparing surgery with radiation therapy are yet available. Data for and comparisons between treatment options should therefore be analyzed with extreme caution.When selecting the best treatment for patients with clinically localized high-risk pca, considerations should include the life expectancy of the patient, the natural history of pca, the curability of the disease, and the morbidity of treatment. High-grade pca managed with noncurative intent greatly reduces life expectancy, but overall, it must also be remembered that radical prostatectomy (rp) and radiotherapy (rt) appear to have similar effects on quality of life. In this population, rp necessitates an extended pelvic lymph node dissection (plnd), but in selected cases, nerve-sparing is a therapeutic possibility and may offer a significant advantage over rt in terms of local control and-although absolutely not yet proved-maybe even in survival. One clear advantage is the ease of administering adjuvant or salvage external-beam rt (ebrt) after rp; conversely, salvage rp after failed ebrt is an exceedingly difficult surgery, with major complications. Surgery therefore has its place, but must be considered in the context of multimodality treatment and the risk of micrometastatic disease. Awaited trial results will help to further refine management in this group of patients.

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Section: S30mentioning

confidence: 99%

Section: S30mentioning

confidence: 99%

Role of Surgery in High-Risk Localized Prostate Cancer

et al. 2010

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“…Of this number, only 22 (0.01%) were selected for salvage prostatectomy, despite well-established significant long-term oncological outcomes in both our own and other published series. [3][4][5] As the number of patients referred for consideration of salvage prostatectomy is unknown, it is difficult to determine if this represents failure of referral or unsuitability for salvage. Certainly, many of the men undergoing primary radiotherapy may have been unsuitable for radical surgery from the start, either due to patient age, comorbidity or a desire to avoid an operation, and so salvage surgery may not have been considered.…”

Section: Discussionmentioning

confidence: 99%

“…The last three modalities have been reported to be curative in selected patients, although a number of series report that successful salvage rates are higher with surgery than either cryotherapy or brachytherapy. [3][4][5] Although tumour recurrence post-radiotherapy is common, and in more than 70% is localized to the prostate gland, salvage prostatectomy in infrequently performed. In a survey of clinicians' treatment recommendations for biochemical recurrence postradiotherapy, only 25% considered salvage prostatectomy the preferred option in patients younger than 65, which fell to 4% in patients over this age.…”

Section: Introductionmentioning

confidence: 99%

Salvage prostatectomy post-definitive radiation therapy: The Vancouver experience

Corcoran¹,

Godoy²,

Studd³

et al. 2012

CUAJ

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Introduction: Prostate cancer recurrence following primary radiation is common. If the recurrence remains localized to the prostate gland, surgical removal may result in long-term local control or cure. Despite the well-established oncological outcomes, salvage prostatectomy is infrequently performed or reported. We present our experience with salvage prostatectomy at a Canadian centre. Methods:We identified all patients undergoing salvage prostatectomy at the Vancouver General Hospital between 1995 and 2010 from a prospectively recorded and maintained prostate cancer database. Details regarding initial presentation, delivery of radiotherapy, clinical features at the time of recurrence, as well as oncological and functional outcomes, were collected. Information regarding postoperative morbidity was collected prospectively and confirmed by retrospective chart review. Results: Over a 15-year period, salvage prostatectomy was successfully completed in 21 patients. With a median follow-up period of 68 months (range: 2-122), 9 (43%) patients experienced a biochemical recurrence, with most failing within the first 2 years of surgery. There were 3 deaths in the cohort, all from prostate cancer, giving a prostate cancer specific and overall survival of 86%. The main postoperative morbidity was bladder neck contracture, occurring in 40%. One patient each developed a recto-urethral fistula and osteitis pubis. Physician-recorded data regarding continence was available in 13 (62%). Of these 13 patients, 10 (85%) men were recorded as dry or using 1 pad per day. Conclusions: This is the first Canadian centre to report that salvage prostatectomy can be performed with favourable oncological and functional outcomes.

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“…[8][9][10] Post-prostatectomy salvage radiotherapy has been shown to be of benefit when performed with low PSA, possibly as soon as failure is detected. [11][12][13] Salvage radiotherapy, with post-surgical PSA values 41 ng ml À1 , is known to result in poor outcome. 12 Such a narrow PSA window clearly poses a significant diagnostic challenge for imaging studies whose aim is to discriminate between local relapse and distant disease to optimally tailor treatment strategy.…”

mentioning

confidence: 99%

Is there a role for positron emission tomography imaging in the early evaluation of prostate cancer relapse?

Greco

Cascini

Tamburrini

2008

Prostate Cancer Prostatic Dis

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The patient population with a rising prostate specific antigen (PSA) post-therapy with no evidence of disease on standard imaging studies currently represents the second largest group of prostate cancer patients. Little information is still available regarding the specificity and sensitivity of positron emission tomography (PET) tracers in the assessment of early biochemical recurrence. Ideally, PET imaging would allow one to accurately discriminate between local vs nodal vs distant relapse, thus enabling appropriate selection of patients for salvage local therapy. The vast majority of studies show a relatively poor yield of positive scans with PSA values o4 ng ml À1 . So far, no tracer has been shown to be able to detect local recurrence within the clinically useful 1 ng ml À1 PSA threshold, clearly limiting the use of PET imaging in the post-surgical setting. Preliminary evidence, however, suggests that 11 C-choline PET may be useful in selecting out patients with early biochemical relapse (PSA o2 ng ml À1 ) who have pelvic nodal oligometastasis potentially amenable to local treatment. The role of PET imaging in prostate cancer is gradually evolving but still remains within the experimental realm. Well-conducted studies comparing the merits of different tracers are needed.

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Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy

Cited by 189 publications

References 15 publications

Role of Surgery in High-Risk Localized Prostate Cancer

Role of Surgery in High-Risk Localized Prostate Cancer

Salvage prostatectomy post-definitive radiation therapy: The Vancouver experience

Is there a role for positron emission tomography imaging in the early evaluation of prostate cancer relapse?

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