Salvage radical prostatectomy morbidity has declined

Salvage radical prostatectomy offers patients with recurrent prostate cancer after radiation therapy an opportunity for long-term cancer control, and the procedure has an “acceptable morbidity profile,” New York- based researchers report in the December issue of the Journal of Urology.

“Salvage radical prostatectomy is technically demanding, but the procedure can be performed safely by an experienced surgeon,” senior investigator Dr. James A. Eastham told Reuters Health. “Although rates of urinary incontinence and erectile dysfunction are higher than after standard radical prostatectomy, these outcomes continue to improve.”Dr. Eastham of Memorial Sloan-Kettering Cancer Center and colleagues came to this conclusion after reviewing data from 100 patients who, between 1984 and 2003, underwent the procedure following external beam or interstitial radiotherapy.Between 1993 and 2003, the major complication rate dropped significantly from 33% to 13% and the rectal injury rate fell from 15% to 2%.Moreover, compared with retropubic interstitial radiotherapy, with or without pelvic lymph node dissection, there was a significantly lower risk of complications following external beam radiotherapy or transperineal interstitial radiotherapy (odds ratio, 0.2).At 5 years, an estimated 68% of patients required one pad daily or less and 39% were not incontinent. Moreover, 23 patients who required three or more pads daily were continent after artificial sphincter placement.Overall, the 5-year potency rate was 28% following unilateral or bilateral nerve-sparing radical prostatectomy. It was 45% in previously potent patients.Thus, the researchers conclude that the “acceptable morbidity profile of salvage radical prostatectomy following external beam radiotherapy and transperineal radiotherapy should persuade more physicians to consider patients for this potentially curative procedure.”(Source: J Urol 2004;172:2239-2243: Reuters Health: Oncolink: December 2004.)