[Radical salvage prostatectomy : Treatment of local recurrence of prostate cancer after radiotherapy].
External beam radiation and low- and high-dose interstitial brachytherapy represent therapeutic alternatives to radical prostatectomy for organ-confined and locally advanced prostate cancer. Local recurrences are described in 5-35% of the patients depending on the individual risk profile, and most recurrences are detected due to asymptomatic PSA rise only. According to the most recent data, recurrences are defined by a PSA increase >2 ng/ml above the post-radiation nadir. Radical salvage prostatectomy represents a secondary local treatment with curative intent in patients with organ-confined recurrences. Preoperative risk factors predicting organ-confined disease are initial LDR brachytherapy, preoperative Gleason biopsy score < or =6, < or =50% biopsy cores involved with cancer, and a PSA doubling time >12 months. Metastatic disease should be ruled out preoperatively by skeletal scintigraphy, computed tomography, or magnetic resonance imaging of the abdomen and the small pelvis, and/or choline PET/CT. Functionality of the lower urinary tract is evaluated by urethrocystoscopy and urodynamics. The most appropriate candidates for radical salvage prostatectomy are patients with organ-confined disease or those with symptomatic local recurrences. In experienced hands, morbidity is low with a continence rate of 83-96% depending on the type of previous radiation therapy. Long-term oncological control can be achieved in more than 80% of the patients.
Heidenreich
A
A
Bereich Uro-Onkologie,Klinik und Poliklinik für Urologie, Uniklinik, Kerpener Strasse 62, 50924, Köln, Deutschland. axel.heidenreich@uk-koeln.de
Semrau
R
R
Thüer
D
D
Pfister
D
D
D014408:Biomarkers, Tumor / Q000097:blood; D001918:Brachytherapy; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D018450:Disease Progression; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D012307:Risk Factors; D016879:Salvage Therapy
D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen