title: A reappraisal of the role of vesicourethral anastomosis biopsy in patient candidates for salvage radiation therapy after radical prostatectomy.
abstract: OBJECTIVE
  To investigate the usefulness of vesicourethral anastomotic biopsy (VUBx) in patients who are candidates for salvage radiotherapy (SalvRT) after radical prostatectomy (RRP).
  
  
  METHODS
  From 1992 to 2001, 98 patients with a PSA failure (PSAf) after RRP underwent SalvRT to the prostatic bed (median dose 70 Gy). In 50/98 patients the VUBx was positive, in 26 negative; 22 patients underwent SalvRT without a prior VUBx. The prognostic impact on biochemical disease-free survival (bNEDs) of histologic confirmation of the local failure was evaluated retrospectively.
  
  
  RESULTS
  In the 40 patients with pre-RT PSA < or = 0.9 ng/mL, no additional prognostic information derived from the VUBx, while, for higher PSA values, a positive histology resulted as a covariate independently predictive of post-RT outcome (5-year bNEDs: 74% vs 42% in the 35 and 23 patients with a positive or negative/not performed VUBx, respectively, P=.03), together with pT, pre-RT PSA < or = 1.5 ng/mL, and PSA doubling time.
  
  
  CONCLUSIONS
  In case of PSAf after RRP, VUBx before SalvRT seems unnecessary for PSA < or = 0.9 ng/mL. For higher values, a positive VUBx seems to always justify a SalvRT, which may not be recommendable, given the nonnegligible risk of an already micrometastatic disease, if the biopsy results are negative.
authors.affiliation: Department of Urology, Vita-Salute University, Milan, Italy. roscigno.marco@hsr.it
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Cesare
authors.initials: C
authors.lastname: Cozzarini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Scattoni
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertini
authors.forename: Luigi
authors.initials: L
authors.lastname: Da Pozzo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pasta
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Angelo
authors.initials: A
authors.lastname: Bolognesi
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiorino
authors.forename: Renzo
authors.initials: R
authors.lastname: Colombo
authors.forename: Ferruccio
authors.initials: F
authors.lastname: Fazio
authors.forename: Patrizio
authors.initials: P
authors.lastname: Rigatti
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011379:Prognosis; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D014521:Urethra / Q000473:pathology* / Q000601:surgery; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery