Predictors for maximal outcome in patients undergoing salvage surgery for radio-recurrent prostate cancer.
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.
Gheiler
E L
EL
Department of Urology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Tefilli
M V
MV
Tiguert
R
R
Grignon
D
D
Cher
M L
ML
Sakr
W
W
Pontes
J E
JE
Wood
D P
DP
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
D017430:Prostate-Specific Antigen