title: Predictors for maximal outcome in patients undergoing salvage surgery for radio-recurrent prostate cancer.
abstract: OBJECTIVE
  To determine preradiation and preoperative clinical staging and postoperative pathologic factors that can predict disease-free survival in patients undergoing salvage surgery for radio-recurrent prostate cancer.
  
  
  METHODS
  A retrospective review was performed on 40 patients who underwent salvage surgery for radio-recurrent prostate cancer. Preradiation and preoperative clinical staging factors, as well as pathologic stage were analyzed as predictors of disease-free survival. Biochemical failure was defined as a persistent serum prostate-specific antigen (PSA) elevation greater than 0.4 ng/mL.
  
  
  RESULTS
  As a group, salvage surgery provided excellent clinical disease control in 35 of 40 patients (87.5%). Overall, 18 of 38 (47.4%) patients analyzed had no evidence of biochemical progression. Preradiation clinical stage and pathologically organ-confined disease were statistically significant predictors of disease-free survival (P = 0.03 and P = 0.02, respectively). Seminal vesicle invasion and positive lymph nodes were the worst pathologic prognostic factors. Preoperative clinical T1c disease approached statistical significance in predicting pathologically organ-confined disease and disease-free survival (P = 0.08 and P = 0.07, respectively).
  
  
  CONCLUSIONS
  Ideal candidates for salvage surgery should have preradiation and preoperative clinically organ-confined disease. All patients with pathologically organ-confined disease following salvage prostatectomy were disease free at a mean follow-up of 36.1 months. Salvage surgery, although technically feasible, should not be widely advocated as an effective curative treatment in patients with locally advanced disease at the time of diagnosis.
authors.affiliation: Department of Urology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Gheiler
authors.forename: M V
authors.initials: MV
authors.lastname: Tefilli
authors.forename: R
authors.initials: R
authors.lastname: Tiguert
authors.forename: D
authors.initials: D
authors.lastname: Grignon
authors.forename: M L
authors.initials: ML
authors.lastname: Cher
authors.forename: W
authors.initials: W
authors.lastname: Sakr
authors.forename: J E
authors.initials: JE
authors.lastname: Pontes
authors.forename: D P
authors.initials: DP
authors.lastname: Wood
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D000368:Aged; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D012669:Seminal Vesicles / Q000473:pathology; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D017430:Prostate-Specific Antigen