Outcomes of salvage radical prostatectomy following more than one failed local therapy

Abstract

PurposeTo describe the salvage radical prostatectomy (sRP) experience in patients presenting with recurrent, clinically localized prostate cancer after multiple failed local treatments.Materials and MethodsAmong the 251 sRP performed during 2000–2016, 11 patients had failed multiple local therapies. We describe baseline clinical characteristics at primary cancer diagnosis and prior to sRP, surgical information, complications and oncological outcomes.ResultsThe mean±standard deviation age at sRP was 65±5 years and the median (interquartile range) serum prostate-specific antigen (PSA) level was 2 (1.3) ng/mL. The most common first and subsequent treatments were radiotherapy and cryotherapy, respectively, with median time of 24 months from the last local treatment. The median operative time was 180 minutes and median estimated blood loss was 750 mL. Five (45.5%) patients underwent additional procedures during sRP for pre-operative morbidity from prior treatments (rectourethral fistula, urethral stricture, incontinence). Post-operative complications requiring invasive intervention occurred in 7 (63.6%) patients. Over a median follow-up of 29 (12–96) months, 10 of the 11 men (90.9%) achieved an undetectable PSA in after sRP. Three of these men with an initially undetectable PSA level experienced biochemical recurrence; the remaining 7 are without evidence of disease. Overall, no local recurrence or systemic metastasis was identified at last follow-up.ConclusionssRP is technically feasible and offers durable cancer control in patients with recurrent prostate cancer despite having undergone multiple prior attempts at cure. These patients experience higher rates of post-operative complications and such patients must be appropriately counseled regarding the potential risks and benefits.

Comparing open and robotic salvage radical prostatectomy after radiotherapy: predictors and outcomes

“…Vesicourethral anastomosis stricture is one of the most feared complications, which needs, in the vast majority of the cases, additional surgical procedures, leading sometimes to severe incontinence that can only be controlled with an artificial urinary sphincter or urinary diversion 12 . Series describing functional outcomes of robotic SRP after primary treatment confirm that complications such as anastomotic stricture are frequent, ranging from 11% to 25.6% 13 as shown in Table 3 .…”