Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review

Giorgio Calleris, Giancarlo Marra, Ettore Dalmasso, Marco Falcone, Robert Jeffrey Karnes, Alessandro Morlacco, Marco Oderda, Rafael Sanchez-Salas, Francesco Soria, Paolo Gontero

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Purpose: Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP. Methods: A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible. Results: sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1% of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60%, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50% and 5-year cancer-specific survival rates are around 90%. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60%. Potency remains difficult to recover. Conclusions: sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.

Original languageEnglish (US)
JournalWorld Journal of Urology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Prostatectomy
Radio
Prostatic Neoplasms
Patient Selection
Recurrence
Anastomotic Leak
Disease-Free Survival
Fear
Dissection
Pathologic Constriction
Radiotherapy
Survival Rate
Databases
Prospective Studies
Radiation
Survival
Neoplasms
Therapeutics

Keywords

  • Prostate cancer
  • Radical prostatectomy
  • Radiotherapy
  • Recurrence
  • Salvage treatment

ASJC Scopus subject areas

  • Urology

Cite this

Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. / Calleris, Giorgio; Marra, Giancarlo; Dalmasso, Ettore; Falcone, Marco; Karnes, Robert Jeffrey; Morlacco, Alessandro; Oderda, Marco; Sanchez-Salas, Rafael; Soria, Francesco; Gontero, Paolo.

In: World Journal of Urology, 01.01.2019.

Research output: Contribution to journalReview article

Calleris, Giorgio ; Marra, Giancarlo ; Dalmasso, Ettore ; Falcone, Marco ; Karnes, Robert Jeffrey ; Morlacco, Alessandro ; Oderda, Marco ; Sanchez-Salas, Rafael ; Soria, Francesco ; Gontero, Paolo. / Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. In: World Journal of Urology. 2019.
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abstract = "Purpose: Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP. Methods: A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible. Results: sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1{\%} of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60{\%}, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50{\%} and 5-year cancer-specific survival rates are around 90{\%}. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60{\%}. Potency remains difficult to recover. Conclusions: sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.",
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AU - Calleris, Giorgio

AU - Marra, Giancarlo

AU - Dalmasso, Ettore

AU - Falcone, Marco

AU - Karnes, Robert Jeffrey

AU - Morlacco, Alessandro

AU - Oderda, Marco

AU - Sanchez-Salas, Rafael

AU - Soria, Francesco

AU - Gontero, Paolo

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N2 - Purpose: Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP. Methods: A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible. Results: sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1% of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60%, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50% and 5-year cancer-specific survival rates are around 90%. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60%. Potency remains difficult to recover. Conclusions: sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.

AB - Purpose: Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP. Methods: A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible. Results: sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1% of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60%, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50% and 5-year cancer-specific survival rates are around 90%. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60%. Potency remains difficult to recover. Conclusions: sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.

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KW - Radical prostatectomy

KW - Radiotherapy

KW - Recurrence

KW - Salvage treatment

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