Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer.
OBJECTIVE
To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa).


METHODS
From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year.


RESULTS
Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy, the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months.


CONCLUSIONS
SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.
Seabra
Daniel
D
Section of Urology, Pio XII Foundation, Barretos, Sao Paulo, Brazil. daniel.seabra@terra.com.br
Faria
Eliney
E
Dauster
Breno
B
Rodrigues
Gunther
G
Fava
Gilberto
G
D000368:Aged; D004307:Dose-Response Relationship, Radiation; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery* / Q000628:therapy; D009367:Neoplasm Staging; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D011836:Radiation Tolerance; D016879:Salvage Therapy / Q000009:adverse effects*; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology
D017430:Prostate-Specific Antigen