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

Abstract

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.

Clinical Significance of Neoadjuvant Combined Androgen Blockade for More Than Six Months in Patients with Localized Prostate Cancer Treated with Prostate Brachytherapy

“…With the recent development of minimally invasive approaches (laparoscopy and robotic laparoscopy), salvage radical prostatectomy has been one of the useful treatment options, if early diagnosis and appropriate selection of patients are done [22]. In recently published salvage BT series, salvage BT may be a candidate of realistic alternative to salvage radical prostatectomy [22]. Promising diagnostic imaging tools to detect the exact local recurrence could improve the outcome of salvage therapy after radiation therapy.…”

Emerging Treatments for Recurrent Prostate Cancer

“…Only a small proportion of men with BCR following EBRT will have SRP (0.9-2%) [16] and good quality prospective trials assessing outcomes are lacking.…”

“…A recent systematic review highlighted that BCR-free survival rates are significantly lower in trials that had longer follow up times (>40 months) indicating the timedependent nature of BCR-free survival as an outcome measure. [16] Case series have described the use of laparoscopic and robotic surgery and overall trends suggest that newer surgical techniques are helping to decrease the morbidity associated with SRP. [19] However morbidity following salvage surgery remains significantly higher compared to primary prostatectomy.…”

“…[16] Case series have described the use of laparoscopic and robotic surgery and overall trends suggest that newer surgical techniques are helping to decrease the morbidity associated with SRP. [19] However morbidity following salvage surgery remains significantly higher compared to primary prostatectomy. In one report, the 90-day major surgical complication rate was 47% versus 5% in the primary prostatectomy population.…”

Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radical radiotherapy

“…В 20-30 % случаев биохимиче-ский рецидив связан с локальным прогрессированием (локальные рецидивы), что говорит о возможности рассмотрения вопроса проведения спасительной (сальважной) терапии [5]. Однако лишь небольшая часть (0,9-2,0 %) этих случаев фактически поддается контролю с помощью спасительной радикальной про-статэктомии, тогда как большинство больных в конеч-ном итоге получают андрогендепривационную тера-пию, вне зависимости от степени распространенности опухолевого процесса [6,7].Назначение андрогендепривационной терапии, как правило, является методом выбора при лечении таких больных. Тем не менее стабильный контроль РПЖ не может быть полностью достигнут только при-менением андрогендепривационной терапии в связи с развитием в конечном итоге кастрационно-рези-стентной фазы заболевания.…”