Salvage Prostate Surgery Effective for Some Men

Patients should be selected carefully because of a higher incidence of locally advanced disease.
Patients should be selected carefully because of a higher incidence of locally advanced disease.

ORLANDO—Salvage radical prostatectomy (SRP) is an effective treatment for some men who experience recurrent prostate cancer (PCa) after radiotherapy, but it is associated with significant peri-operative complication rates, investigators concluded in a presentation at the American Urological Association 2014 annual meeting.

Patients should be selected carefully for the procedure because of a higher incidence of locally advanced disease and regional lymph node metastases.

In a study of 41 men who underwent SRP following radiotherapy failure, Ali Al-Daghmin, MD, of Roswell Park Cancer Institute in Buffalo, N.Y., and colleagues found SRP is associated with a 10-year biochemical progression-free survival rate of 32% and a 10-year overall survival rate of 60%. The study population had a median follow-up of 88 months, the longest median follow-up ever reported for an SRP series, according to the investigators.

Intra-operatively, 9 patients (22%) required a blood transfusion, 3 (7%) suffered a rectal injury, and 1 (2%) had an obturator nerve injury intra-operatively. Post-operatively, 4 patients (10%) required a blood transfusion, 6 had a fever above 38.5 degrees C (15%), 4 had a wound infection (10%), 14 (34%) experienced bladder neck contracture, and 12 (29%) required bladder neck closure procedures.

Of 38 patients evaluable at baseline, 45% had urinary incontinence and 32% had erectile dysfunction (ED). At 6 months, 88% and 78% of 40 evaluable patients had UI and ED, respectively. These proportions declined over time to 42% and 25% of 24 evaluable patients at 36 months.

With respect to pathologic findings, 46% had prostatic capsular penetration, 32% had seminal vesical invasion, 17% had positive surgical margins, and 12% of patients had positive pelvic lymph nodes. In addition, 44%, 54%, and 3% of patients had pT2, pT3, and pT4 disease, respectively.

To be included in the study, patients needed to be at least 18 months post-radiotherapy and have a PSA level of 20 ng/mL or less, biopsy-proven persistent or recurrent PCa, and no radiologic evidence of metastatic disease.

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