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.