gms | German Medical Science

Introduction: Although technically challenging, salvage prostatectomy (SRP) for radio recurrent prostate cancer (PCA) is an effective option in carefully selected patients and offers the chance for the cure and long-term survival. Sometimes local progression of PCA with subvesical obstruction following primary androgen deprivation requires radical cystoprostatectomy if radiation therapy is not indicated. We present our experience with salvage prostatectomy in these cases.

Methods: Between 1/2003 and 8/2005 28 consekutive underwent SRP for locally recurrent prostate cancer (PCA) after external beam radiation (n=14), high dose brachytherapy (n=8) and low dose brachytherapy (n=6). All men had biopsy proved recurrent or persistent PCA associated with PSA progression following radiation therapy. Preoperative imaging studies included bone scintigraphy and computed tomography and all were without evidence of metastatic disease. Life expectancy was > 10 years in all cases. After a mean follow-up of 12.5 (2-29) months, we analyzed preoperative symptoms, treatment associated morbidity, pathohistological findings, functional and oncological outcome.

Results: 21 men underwent salvage RP and in 7 radical cystoprostatectomy (RCx) due to bladder neck infiltration had to be performed. Mean surgical time was 145 and 215 minutes for the RP and the RCx group, resp.; mean intraoperative blood loss was 520 ml. Mean catheterization and hospitalization time for the RP group was 7.5 days and 10 days, resp.; mean hospitalization was 15.5 days for the RCx group. There were no significant intra or perioperative complications, no rectal or ureteral injuries were encountered. Pathohistological analysis of the prostatectomy specimens revealed pT1-2b PCA in 20 (72%) patients, pT3b in 5 (18%) and pTxpN1 in 3 (11%) patients. Positive surgical margins were encountered in 2 cases; 20% of the men revealed a Gleason score PCA. After a mean follow-up of 12.5 months, 25% of men demonstrate urinary stress incontinence with the need of 1-2 pads per day. All men with bladder neck infiltration had a significant relief of urgency and significant irritative voiding dysfunction. Currently, 2 patients with locally advanced recurrent PCA demonstrate PSA progression.

Conclusions: Salvage RP or RCx is a technically challenging but feasible and a curative surgical approach for the treatment of locally recurrent PCA in well selected patients. Complications and morbidity are low and not comparable to earlier series. Indication for surgery should be based on preoperative biopsy findings and negative imaging studies. SRP should be considered early in the decision process for the management in locally recurrent PCA after various types of radiation therapy. It should, however, be performed in experienced centres.