Outcomes of laparoscopic salvage radical prostatectomy after primary treatment of prostate cancer

Abstract

Introduction Treatment of radio-recurrent prostate cancer (PC) is managed mainly by androgen deprivation therapy. Nonetheless, selected patients could benefit from local salvage treatment options. In this study we present our series of recurrent PC cases submitted to laparoscopic salvage radical prostatectomy (sRP) at our institution. Material and methods A total of 29 patients with recurrent PC after primary non-surgical treatment were submitted to laparoscopic sRP at our institution, with a mean follow-up time of 7 years. Results There were 7 post-operative complications Clavien-Dindo grade ≥2. At the end of the follow-up, 58.6% patients presented biochemical recurrence and five-year recurrence-free survival (RFS) was 50%. Positive lymph nodes, high preoperative prostate-specific antigen (PSA) and TNM stage were correlated with worse RFS. Cox regression analysis demonstrated that stage pT3b was independently associated with worse RFS in comparison with stage pT3a or less. At 12 months, pad-free continence or mild incontinence was observed in 62% of the patients. Conclusions sRP is a technically challenging surgery, and in our series, we were able to perform this procedure with acceptable operative time and limited blood loss. Post-operative complications, functional results and oncological outcomes were similar to other published studies, being our series, to the best of our knowledge, the one with the longest follow-up, of 7 years. sRP is a feasible local treatment with curative intent for radio-recurrent prostate cancer, with good oncological outcomes and reasonable continence rates in selected patients.

The Role of Salvage Radical Prostatectomy in Patients with Radiation-Resistant Prostate Cancer

“…Catarino et al examined 29 patients treated with laparoscopic salvage RP and reported that 5-year BFS was 50% with a positive surgical margin rate of 27.6%, although surgical margin status and pre-RP biopsy Gleason score did not affect BFS. However, positive lymph nodes, high pre-RP serum PSA, and high TNM stage were correlated with worse BFS [38]. Most recently, Calleris et al looked to validate the European Association of Urology (EAU) guidelines that recommend restricting salvage radical prostatectomy for radio-recurrent prostate cancer to a favorable-prognosis group: those with organ-confined prostate cancer ≤ stage T2b, pre-RP Gleason score ≤ 7, and pre-SP PSA levels <10 ng/mL [39].…”