title: Salvage radical prostatectomy after radiotherapy.
abstract: OBJECTIVE
  To determine the oncological and functional results obtained after salvage radical prostatectomy (SRP) in patients with recurrence following radiotherapy (3 consecutive PSA rises after a nadir until the year 2006, then 2 ng/mL above nadir ) for prostate cancer (PC), and to analyze the impact of different pre-and postoperative variables on biochemical recurrence-free survival (BCR-free survival).
  
  
  METHODS
  Retrospective analysis of 29 cases treated with SRP, 23 cases of conventional technique and 6 cases assisted by the Da Vinci surgical system between August 2004 and March 2012 at the Hospital Italiano de Buenos Aires. There was an attempt to preserve neurovascular bundles in cT1c patients with low tumor volume, Gleason score 7 or less, and favorable surgical anatomy. The degrees of postoperative incontinence and erectile function were recorded. The overall survival, the disease-specific survival, and the BCR-free survival were assessed. The BCR-free survival was compared among groups in accordance with the pre-and post-operative variables. RESULTS. No complications,injury to nearby organs or blood transfusions were recorded. Of all the patients, 85.7% showed normal continence (no pads used). Eight patients (27.5%) preserved their potency with sildenafil. There were 6 positive margins for tumor extension, 44.8% of pT3a, and 10.3% pT3b. All patients are alive at present, and 58.6% with at least 1 year of follow-up have a PSA with recovery criteria (less than 0.02 ng/mL). The biochemical recurrence (BCR) was 41.3%, and the estimated 4-year BCR-free survival was 51.7%. Of the groups analyzed, the presence of a preoperative Gleason score ≥8 and the presence of positive surgical margins (PSMs) significantly influenced the BCR-free survival, both in the univariate as well as the multivariate analysis (p=0.02 and 0.017, respectively). CONCLUSIONS. SRP is a challenging and achievable surgery with an acceptable complication rate, and constitutes a chance to cure patients with biochemical recurrence following prostate radiotherapy. The presence of a preoperative Gleason score ≥8, and the presence of PSMs in the specimen increase the chances of a BCR after four years post-SRP.
authors.affiliation: Servicio de Urologia y Servicio de Anatomia Patologica.Hospital Italiana de Buenos Aires.Buenos Aires. Argentina.
authors.forename: Pablo F
authors.initials: PF
authors.lastname: Martinez
authors.forename: Nicolas
authors.initials: N
authors.lastname: Billordo Peres
authors.forename: Christian
authors.initials: C
authors.lastname: Cristallo
authors.forename: Mariano
authors.initials: M
authors.lastname: Isola
authors.forename: Wenceslao
authors.initials: W
authors.lastname: Villamil
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Giudice
authors.forename: Oscar
authors.initials: O
authors.lastname: Damia
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D016019:Survival Analysis