Salvage radical prostatectomy after local radiotherapy in prostate cancer

Abstract

Purpose of reviewSalvage surgeries are rarely offered and performed in prostate cancer except for isolated lymph node metastases. Meanwhile, data are sufficient that salvage radical prostatectomy is recommended by the guidelines. In the following review, we focus on different treatment strategies comparing open and DaVinci laparoscopic approach with regard to functional and oncologic outcome. Of further interest are palliative surgeries.Recent findingsSalvage radical prostatectomy is mainly performed in high volume centres. Data are increasing on minimal invasive surgery, although data on functional outcome are conflicting. As patients with prostate cancer have longer life expectancy even in metastasized disease, the possibility of developing symptomatic progression increases as well. We need to be aware that the confrontation with symptomatic prostate cancer patients will be more frequent in the future and that there are surgical approaches to palliate these patients sufficiently.SummaryData on minimal invasive salvage radical prostatectomy are getting more valid and are an option in experienced centres. Salvage radical prostatectomy is a definitive curative option for the patients. To avoid local progression, palliative local surgeries need to be discussed with the patients.

Salvage irreversible electroporation for radio‐recurrent prostate cancer – the prospective FIRE trial

“…Unlike the treatment of biochemical recurrence post radical prostatectomy (RP), treatment of locally recurrent PCa after definitive radiotherapy is controversial. Treatment options include salvage RP, repeat radiotherapy or whole gland/focal ablation [5][6][7]. However, all local salvage options carry high rates of severe genitourinary and gastrointestinal side effects.…”

Salvage cryotherapy for prostate cancer

“…In our study, 34 patients 61.8% did not report any significant side effects, a rate higher than average. The most common side effects were both urge incontinence and mild urinary incontinence reported in 7 patients, less severe when compared to side effects reported after salvage prostatectomy where severe continence is present in 25% of patients (7,26,29). Only one patient presented with a fistula; he was a 72-year-old patient submitted to prior brachytherapy with combined radiotherapy for ISUP 5 disease.…”

“…Functional outcomes differ significantly between treatment options although most patients present already with a low erection capacity after previous treatment with radiotherapy. After surgery (salvage radical prostatectomy), almost no patient retains erectile function and 25% of patients presents with severe incontinence and significantly lower rates of continence compared to other salvage treatments or surgery as primary treatment (28,29).…”

Introduction of salvage prostatectomy in Denmark: the initial experience

“…However, none of the patients were considered to need evaluation for artificial sphincter surgery. This illustrates that preserving the continence mechanisms is a challenge and require that sRARP is performed in high-volume centers only [ 18 ].…”