Salvage prostatectomy in patients who have failed radiation therapy or cryotherapy as primary treatment for prostate cancer.
Asymptomatic prostate-specific antigen (PSA) recurrence after radiation therapy for prostate carcinoma poses a diagnostic and therapeutic dilemma for clinicians. Patients with locally recurrent disease can consider treatment options of salvage surgery, cryotherapy, watchful waiting, or androgen deprivation. Of these options, only salvage surgery has been shown to result in long-term disease-free survival for selected patients. However, salvage surgery is associated with significant morbidity, including urinary incontinence and rectal injuries. Ideally, salvage surgery outcomes can be optimized with careful patient selection according to clinical stage, serum PSA levels before radiation and surgery, the medical condition of the patient, and clear expectations of the physician and patient. Among patients with locally recurrent disease, those with localized prostate carcinoma amenable to radical prostatectomy before radiation or cryotherapy would be the most suitable candidates for salvage surgery.
Chen
Bert T
BT
Department of Urology, University of Michigan, Ann Arbor, Michigan 48103, USA.
Wood
David P
DP
D000230:Adenocarcinoma / Q000532:radiotherapy / Q000601:surgery* / Q000628:therapy; D000726:Androgen Antagonists / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D017679:Cryotherapy; D015653:Cystectomy; D018572:Disease-Free Survival; D006801:Humans; D008297:Male; D009363:Neoplasm Proteins / Q000097:blood; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000601:surgery; D018579:Patient Selection; D011183:Postoperative Complications; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery* / Q000628:therapy; D016879:Salvage Therapy; D016896:Treatment Outcome
D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D009363:Neoplasm Proteins; D017430:Prostate-Specific Antigen