Salvage Radical Prostatectomy for Radiorecurrent Adenocarcinoma of the Prostate

Abstract

A total of 16 patients with persistent or recurrent prostate cancer 1 to 10 years after definitive treatment with radiotherapy underwent salvage radical prostatectomy. Patients considered to be candidates for the procedure were in excellent health, with a life expectancy of at least 10 years and with no evidence of extension of tumor beyond the prostate. There was no operative mortality but major complications included rectal injury in 3 patients (19 per cent, 1 requiring colostomy), ureteral transection in 1 (6 per cent), anastomotic stricture in 4 (25 per cent), ureterovesical junction stricture in 1 (6 per cent) and persistent urinary incontinence in 4. Whole organ step-section of the surgical specimen revealed positive surgical margins in 6 patients (37.5 per cent). Margins usually were positive at the apex and not at the bladder neck, so that cystoprostatectomy would not have altered the positive margin rate. Although the followup is too short for analysis of tumor recurrence or patient survival rates, the results indicate that salvage radical prostatectomy, although technically demanding, is feasible and that in the majority of properly selected patients the tumor can be removed completely.

Anastomotic Stricture after Radical Prostatectomy

“…It is remarkable that the incidence of subvesical obstruction by urethral strictures is 5–9% after transurethral resection of benign prostatic hyperplasia [8, 9], 8–19% after percutaneous radiation of prostate cancer [10, 11, 12, 13, 14] and 57% after antiandrogen (estrogen) therapy of prostatic cancer [15]. …”

“…After salvage radical prostatectomy for radiorecurrent prostate cancer anastomotic strictures occur in up to 25% [12, 13]. …”

Current Controversies in the Management of Localized Prostate Cancer

“…Reported 10-year overall survival rates after radiotherapy appear to be comparable to other forms of management ( l which provides excellent local control and delays métas tasés with little morbidity [83,84], recurrence, and the greater risks of distant métastasés in patients whose local tumor is not controlled [76,77], sub stantially reduce the long-term survival rates of patients treated with radiotherapy. If the tumor recurs locally after definitive radiotherapy, it is difficult to detect while it is still confined to the prostate and treatment (for example, with salvage radical prostatectomy) carries substantial risks [78], The new technique of three-dimensional con formal radiotherapy attempts to increase the dose of irra diation without increasing the damage to surrounding normal tissue [79,80],…”

Eingeschränkte Therapie beim Prostatakarzinom

“…[17]. Eine sekundäre operative Exstirpation der Prostata wird unter diesen Umständen von einigen Zentren befürwortet und ausgeführt [12,14]. Keineswegs ist cs auf der anderen Seite so, daß bei primär operativer Behandlung eine lokale Radikalität generell gesi chert ist.…”