Salvage surgery should be considered in well-selected patients who have persistent prostate cancer after undergoing definitive radiotherapy, investigators contend in a report in the April issue of The Journal of Urology.
In their 30-year experience, “significant” progression-free survival and cancer-specific survival can be expected following salvage surgery for prostate cancer that recurs after radiotherapy.”We have long disagreed with the reluctant use of salvage surgery in well-selected patients,” write Dr. John F. Ward from the Naval Medical Center in Portsmouth, Virginia and colleagues.They report contemporary outcomes with salvage surgery in 199 patients with biopsy proven prostate cancer following definitive radiotherapy, including 138 who underwent retropubic prostatectomy and 61 who underwent cystoprostatectomy.Overall 10-year cancer-specific survival for all patients was 65%, they report. The mean progression-free and cancer-specific survival in all patients following surgery was 7.8 and 12.2 years, respectively.Patients who underwent retropubic prostatectomy fared better overall than those who underwent cystoprostatectomy. The 10-year cancer-specific survival was 77% for retropubic prostatectomy versus 38% for cystoprostatectomy, and median progression-free survival was 8.7 years versus 4.4 years, respectively.Gleason score, tumor ploidy, and pathological stage of the excised tumor were significant predictors of progression-free survival and cancer-specific survival. The preoperative serum PSA, on the other hand, has “little prognostic value” and, in some cases, “may be counterintuitive,” they found.The data also show that morbidity rates, including continence, “moderately improved with time.” Urinary continence, defined as needing 0 pads, improved from 43% to 56% following salvage surgery, “with an additional 20% requiring 1 or fewer pads daily,” the researchers report.The most common complications — urinary extravasation and bladder neck contracture — occurred in 15% and 22% of patients, respectively.Salvage surgery following initial treatment of localized prostate cancer with radiotherapy is “a feasible and viable option for a growing number of young healthy men,” they conclude.Men with life expectancy of 10 years or more and localized tumors receptive to retropubic prostatectomy are most likely to benefit from salvage surgery, they say. This series of patients, the authors add, could serve as a contemporary benchmark against which newer treatments can be compared.(Source: J Urol 2005;173:1156-1160: Reuters Health: Oncolink: May 2005.)