Salvage radical prostatectomy for radiorecurrent prostate cancer: Indications and results

Review of: Darras J, Joniau S, Van Poppel H. Eur J Surg Oncol. 2006 Jun 29; [Epub ahead of print]

Salvage radical prostatectomy has previously been considered to be a major challenge even for welltrained surgeons. However, it may become a more common and important therapy in the future as a rise in the incidence of radiorecurrent prostate cancer is to be expected. Recently, Darras and collaborators from Belgium, reported their own 15-year data in 11 patients who underwent salvage radical prostatectomy after failure of radiotherapy. The aim of the study was to look into their own experience with salvage radical prostatectomy and to analyse outcome and morbidity. The design was to identify patients who underwent salvage radical prostatectomy for radiorecurrent cancer over the last 15 years.

The most common complication was bladder neck stricture (18%). Mean age at surgery was 60.5 years and mean time to salvage surgery was 36.9 months. The biochemical disease-free survival was 55% and overall and cancer-specific survival was 91%, after a mean follow-up of 6.9 years. The authors reported no intraoperative complications, although the surgical procedures were difficult. Continence rates were not worse after salvage prostatectomy than after a standard radical prostatectomy as primary treatment for localized prostate cancer. No nerve-sparing procedures was undertaken and all 11 patients were impotent after salvage prostatectomy.

Since approximately one third of early prostate cancer cases are nowadays treated with a radiotherapy modality, including brachytherapy, a substantial rise in the incidence of recurrent prostate cancer after radiotherapy is to be expected. One possibility in treating radiorecurrent prostate cancer is salvage prostatectomy, which offers a Ƭsecond chance for cureƮ, in carefully selected patients. Not many centers have offered salvage radical prostatectomy, as the procedure has been considered as very difficult and with a great risk for complications. Besides the present report from Darras and collaborators, a limited number of other urological centers with a large experience in standard radical prostatectomies, have reported promising results of salvage prostatectomy. Based on this and previous publications, it seems clear that salvage radical prostatectomy may become an important treatment of choice and offer a second chance for cure in selected patients after failure of radiotherapy. Outcome is particularly favourable in patients with initial and pre-salvage low serum PSA and an initial low clinical stage. Alternative methods for focal therapy of prostatic tumours are currently being developed and must not be forgotten.

Author: Anders Bjartell

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