Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic, Histopathologic and Functional Outcomes and Predictors of Good Response

Abstract

A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5–52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended.

Evolution of Salvage Radical Prostatectomy from Open to Robotic and Further to Retzius Sparing Surgery

“…Considering oncological outcome, 5-year recurrence free survival rates of 34% to 83% for salvage prostatectomy are described [ 41 ]. In our own series, long term follow-up especially for rsRARP is missing.…”

Salvage radical prostatectomy

“…Although some patients with BCR never develop distant metastasis or die from their disease, many suffer from disease progression. A recent meta-analysis reported that 5-year biochemical recurrence-free survival after sRP ranges from 34 to 83% [8 ▪ ]. Currently, there is no validated tool to predict recurrence after sRP.…”

Oncologic Impact and Safety of Pre-Operative Radiotherapy in Localized Prostate and Bladder Cancer: A Comprehensive Review from the Cancerology Committee of the Association Française d’Urologie

“…However, several retrospective studies have assessed the functional outcomes after sRP in the context of delayed surgery for local recurrence. The overall median time to sRP was 51 months in a recent literature review [ 56 ]. Globally, sRP appeared to be feasible without a significant increase in major complication rates.…”

“…The main issue of this salvage procedure continues to be a high rate of urinary incontinence. The rates of urinary continence varied from 20% to 90% at 1 year in the literature, according to the definition that was used (number of daily pads) [ 56 ].…”

“…Nerve-sparing techniques cannot be performed for the majority of patients because of the need for extensive surgery in the context of local recurrence and given the perioperative technical difficulties that are caused by the peri-prostatic fibrosis that is induced by a previous RT regimen. Grubmüller et al reported a post-sRP erectile function rate ranging from 0% to 13% [ 56 ]. In a recent, comparative series of robotic sRP versus primary RP, Nathan et al did not find significant differences in terms of high-grade complication rates [ 57 ].…”