Perineal salvage prostatectomy for radiation resistant prostate cancer.
OBJECTIVE
No data are available on the use of perineal prostatectomy for salvage treatment of local recurrent prostate cancer after radiotherapy. Here we report on the clinical aspects and follow-up of salvage perineal prostatectomy.


METHODS
Twenty-seven patients underwent a perineal salvage prostatectomy from 1997-2005 for biopsy-proven local recurrent prostate cancer after external beam (n=22) or brachyradiotherapy (n=5). Staging included physical examination, prostate-specific antigen (PSA), transrectal ultrasound, computed tomography scan, and bone scan.


RESULTS
Mean PSA before surgery was 8.6 ng/ml (+/-2.8 ng/ml). Comparing clinical staging with final pathologic staging after salvage perineal prostatectomy showed a 67% clinical understaging. Mean blood loss was 677 cc, and perioperative morbidity consisted of prolonged anastomotic leakage (n=8), urosepsis (n=3), prolonged hematuria (n=3), urinary retention (n=2), and rectal perforation (n=1). One patient died during the postoperative course because of urosepsis and endocarditis. At an interval of at least 12 mo after surgery, 37% (10 of 27) and 7% (2 of 27) of patients reported normal continence and erectile function, respectively. Five patients died during a mean follow-up of 43 mo; two patients died of prostate cancer. Five-year biochemical recurrence-free survival was 31% (95%CI, 25-42%). In a multivariate Cox regression analysis the serum PSA and PSA doubling time (PSADT) at the time of surgery were the best predictors of biochemical recurrence-free survival. No patient with a PSA>2 ng/ml and a PSADT<12 mo was without biochemical recurrence 2 yr after surgery.


CONCLUSIONS
Salvage perineal prostatectomy showed functional results that favorably compare with the retropubic approach, but considerable morbidity is still frequent. Proper patient selection therefore is mandatory. A serum PSA level of >2 ng/ml and PSADT<12 mo independently predict shorter biochemical recurrence-free survival.
van der Poel
Henk G
HG
Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. h.vd.poel@nki.nl
Beetsma
Daan B
DB
van Boven
Hester
H
Horenblas
Simon
S
D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010502:Perineum / Q000601:surgery*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D016879:Salvage Therapy; D016019:Survival Analysis; D016896:Treatment Outcome
D017430:Prostate-Specific Antigen