Salvage surgery for radiorecurrent prostate cancer: Contemporary outcomes

John F. Ward, Thomas J. Sebo, Michael L. Blute, Horst Zincke

Research output: Contribution to journalArticle

165 Citations (Scopus)

Abstract

Purpose: We present a 30-year experience with performing salvage surgery in patients with persistent prostate cancer (PCA) after definitive radiotherapy. Materials and Methods: Patients with biopsy proven PCA following definitive radiotherapy who underwent salvage surgery were identified retrospectively (1967 to 2000). Prostate specimens were evaluated by a single pathologist. Progression-free survival (PFS) and cancer specific survival (CSS) estimates were made with multivariate analysis of outcome predictors. Complications were reviewed. Results: Sufficient information was available on 199 patients, including 138 with retropubic prostatectomy (RP) and 61 with cystoprostatectomies (CP). Median followup was 7.0 years. Rectal injury rates (5% for RP and 10% for CP) remained stable, while transfused units of blood decreased. Urinary extravasation (15% of cases) and bladder neck contracture (22%) were the most common complications. Urinary continence (0 pads) improved from 43% to 56% of patients (p = 0.17) with an additional 20% requiring 1 or fewer pad daily. Overall 10-year CSS in all patients undergoing salvage surgery was 65%. Patients undergoing RP fared better than those needing CP (10-year CSS 77% vs 38%, p <0.001 and median PFS 8.7 vs. 4.4 years, p <0.001). Tumor ploidy, percent 4/5 Gleason grade and pathological stage were strong predictors of outcome, while margin status and preoperative prostate specific antigen had minimal predictive strength. Conclusions: Significant PFS and CSS can be expected following salvage surgery for radioresistant PCA. Several pathological features of the removed prostate are predictive of survival. The surgical risks of salvage surgery are now defined. Morbidity rates, including continence, have moderately improved with time.

Original languageEnglish (US)
Pages (from-to)1156-1160
Number of pages5
JournalJournal of Urology
Volume173
Issue number4
DOIs
StatePublished - Apr 2005

Fingerprint

Prostatic Neoplasms
Prostatectomy
Survival
Disease-Free Survival
Neoplasms
Prostate
Radiotherapy
Ploidies
Contracture
Prostate-Specific Antigen
Urinary Bladder
Multivariate Analysis
Morbidity
Biopsy
Wounds and Injuries

Keywords

  • Prostate
  • Prostatectomy
  • Prostatic neoplasms
  • Radiotherapy
  • Salvage therapy

ASJC Scopus subject areas

  • Urology

Cite this

Salvage surgery for radiorecurrent prostate cancer : Contemporary outcomes. / Ward, John F.; Sebo, Thomas J.; Blute, Michael L.; Zincke, Horst.

In: Journal of Urology, Vol. 173, No. 4, 04.2005, p. 1156-1160.

Research output: Contribution to journalArticle

Ward, John F. ; Sebo, Thomas J. ; Blute, Michael L. ; Zincke, Horst. / Salvage surgery for radiorecurrent prostate cancer : Contemporary outcomes. In: Journal of Urology. 2005 ; Vol. 173, No. 4. pp. 1156-1160.
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abstract = "Purpose: We present a 30-year experience with performing salvage surgery in patients with persistent prostate cancer (PCA) after definitive radiotherapy. Materials and Methods: Patients with biopsy proven PCA following definitive radiotherapy who underwent salvage surgery were identified retrospectively (1967 to 2000). Prostate specimens were evaluated by a single pathologist. Progression-free survival (PFS) and cancer specific survival (CSS) estimates were made with multivariate analysis of outcome predictors. Complications were reviewed. Results: Sufficient information was available on 199 patients, including 138 with retropubic prostatectomy (RP) and 61 with cystoprostatectomies (CP). Median followup was 7.0 years. Rectal injury rates (5{\%} for RP and 10{\%} for CP) remained stable, while transfused units of blood decreased. Urinary extravasation (15{\%} of cases) and bladder neck contracture (22{\%}) were the most common complications. Urinary continence (0 pads) improved from 43{\%} to 56{\%} of patients (p = 0.17) with an additional 20{\%} requiring 1 or fewer pad daily. Overall 10-year CSS in all patients undergoing salvage surgery was 65{\%}. Patients undergoing RP fared better than those needing CP (10-year CSS 77{\%} vs 38{\%}, p <0.001 and median PFS 8.7 vs. 4.4 years, p <0.001). Tumor ploidy, percent 4/5 Gleason grade and pathological stage were strong predictors of outcome, while margin status and preoperative prostate specific antigen had minimal predictive strength. Conclusions: Significant PFS and CSS can be expected following salvage surgery for radioresistant PCA. Several pathological features of the removed prostate are predictive of survival. The surgical risks of salvage surgery are now defined. Morbidity rates, including continence, have moderately improved with time.",
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