Salvage prostatectomy post-definitive radiation therapy: The Vancouver experience

Abstract

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.

Contemporary Management of Vesico-Urethral Anastomotic Stenosis After Radical Prostatectomy

“…Notably, VUAS rates in men who had to undergo salvage RP after failed radiotherapy is significantly higher (22-40%). However, this evidence originates from small case series (20,21). Beyond VUAS, salvage therapies come along with a much higher risk of urinary incontinence, rectal injury and urorectal fistulae (22).…”

Radical prostatectomy in high‐risk prostate cancer

“…72 Although the cancer outcomes are good after salvage surgery, it is still true that RT is better tolerated after RP than the other way around in men requiring additional treatment for their aggressive prostate cancer. [74][75][76] What are the pros and cons of radical prostatectomy in men with high-risk prostate cancer?…”

“…The CSS after salvage RP has been reported as 73% at 10 years and 60% at 15 years . Although the cancer outcomes are good after salvage surgery, it is still true that RT is better tolerated after RP than the other way around in men requiring additional treatment for their aggressive prostate cancer …”