Salvage surgery for radiorecurrent prostate cancer: contemporary outcomes.
OBJECTIVE
We present a 30-year experience with performing salvage surgery in patients with persistent prostate cancer (PCA) after definitive radiotherapy.


METHODS
Patients with biopsy proven PCA following definitive radiotherapy who underwent salvage surgery were identified retrospectively (1967 to 2000). Prostate specimens were evaluated by a single pathologist. Progression-free survival (PFS) and cancer specific survival (CSS) estimates were made with multivariate analysis of outcome predictors. Complications were reviewed.


RESULTS
Sufficient information was available on 199 patients, including 138 with retropubic prostatectomy (RP) and 61 with cystoprostatectomies (CP). Median followup was 7.0 years. Rectal injury rates (5% for RP and 10% for CP) remained stable, while transfused units of blood decreased. Urinary extravasation (15% of cases) and bladder neck contracture (22%) were the most common complications. Urinary continence (0 pads) improved from 43% to 56% of patients (p = 0.17) with an additional 20% requiring 1 or fewer pad daily. Overall 10-year CSS in all patients undergoing salvage surgery was 65%. Patients undergoing RP fared better than those needing CP (10-year CSS 77% vs 38%, p <0.001 and median PFS 8.7 vs. 4.4 years, p <0.001). Tumor ploidy, percent 4/5 Gleason grade and pathological stage were strong predictors of outcome, while margin status and preoperative prostate specific antigen had minimal predictive strength.


CONCLUSIONS
Significant PFS and CSS can be expected following salvage surgery for radioresistant PCA. Several pathological features of the removed prostate are predictive of survival. The surgical risks of salvage surgery are now defined. Morbidity rates, including continence, have moderately improved with time.
Ward
John F
JF
Division of Urology, Department of Surgery, Naval Medical Center, Portsmouth, Virginia, USA. jfward@mar.med.navy.mil
Sebo
Thomas J
TJ
Blute
Michael L
ML
Zincke
Horst
H
D000368:Aged; D001803:Blood Transfusion; D015653:Cystectomy / Q000009:adverse effects; D018572:Disease-Free Survival; D005122:Exudates and Transudates; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009367:Neoplasm Staging; D011003:Ploidies; D011183:Postoperative Complications; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012007:Rectum / Q000293:injuries; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D016896:Treatment Outcome; D001748:Urinary Bladder Neck Obstruction / Q000209:etiology; D014549:Urinary Incontinence / Q000209:etiology; D014556:Urine
D017430:Prostate-Specific Antigen