Investig Clin Urol.  2018 May;59(3):152-157. 10.4111/icu.2018.59.3.152.

Outcomes of salvage radical prostatectomy following more than one failed local therapy

• Sivaraman
• Scardino P
• Eastham J

• KMID: 2410587
• DOI: http://doi.org/10.4111/icu.2018.59.3.152

Abstract

PURPOSE
To describe the salvage radical prostatectomy (sRP) experience in patients presenting with recurrent, clinically localized prostate cancer after multiple failed local treatments.
MATERIALS AND METHODS
Among the 251 sRP performed during 2000-2016, 11 patients had failed multiple local therapies. We describe baseline clinical characteristics at primary cancer diagnosis and prior to sRP, surgical information, complications and oncological outcomes.
RESULTS
The mean±standard deviation age at sRP was 65±5 years and the median (interquartile range) serum prostate-specific antigen (PSA) level was 2 (1.3) ng/mL. The most common first and subsequent treatments were radiotherapy and cryotherapy, respectively, with median time of 24 months from the last local treatment. The median operative time was 180 minutes and median estimated blood loss was 750 mL. Five (45.5%) patients underwent additional procedures during sRP for pre-operative morbidity from prior treatments (rectourethral fistula, urethral stricture, incontinence). Post-operative complications requiring invasive intervention occurred in 7 (63.6%) patients. Over a median follow-up of 29 (12-96) months, 10 of the 11 men (90.9%) achieved an undetectable PSA in after sRP. Three of these men with an initially undetectable PSA level experienced biochemical recurrence; the remaining 7 are without evidence of disease. Overall, no local recurrence or systemic metastasis was identified at last follow-up.
CONCLUSIONS
sRP is technically feasible and offers durable cancer control in patients with recurrent prostate cancer despite having undergone multiple prior attempts at cure. These patients experience higher rates of post-operative complications and such patients must be appropriately counseled regarding the potential risks and benefits.

Keyword

Cryosurgery; Prostatectomy; Prostatic neoplasms; Recurrence; Salvage therapy

MeSH Terms

Cryosurgery
Cryotherapy
Diagnosis
Fistula
Follow-Up Studies
Humans
Male
Neoplasm Metastasis
Operative Time
Prostate-Specific Antigen
Prostatectomy*
Prostatic Neoplasms
Radiotherapy
Recurrence
Risk Assessment
Salvage Therapy
Urethral Stricture
Prostate-Specific Antigen

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