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[Salvage radical prostatectomy].

R E Hautmann1

  • 1Urologische Universitätsklinik Ulm, Prittwitzstrasse 43, 89075, Ulm, Germany. richard.hautmann@uniklinik-ulm.de

Der Urologe. Ausg. A
|September 20, 2006
PubMed
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Salvage radical prostatectomy can be a successful treatment for recurrent prostate cancer after radiation therapy. Careful patient selection is crucial due to potential complications like incontinence.

Area of Science:

  • Urology
  • Oncology
  • Surgical Oncology

Context:

  • Locoregional recurrence of prostate cancer after radiation therapy affects 30-50% of patients.
  • Radical salvage prostatectomy offers curative intent but is infrequently performed (<2%).
  • This review examines the frequency, technique, success rates, and complications of salvage prostatectomy in the literature.

Purpose:

  • To review the world literature on radical salvage prostatectomy following radiotherapy for prostate cancer.
  • To assess the frequency of this procedure, surgical techniques, and outcomes.
  • To evaluate the prospects of success and potential complications associated with salvage prostatectomy.

Summary:

  • Predictors of local failure after radiotherapy include PSA nadir, time to nadir, and PSA doubling time.

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  • 5-year biochemical relapse-free survival rates vary by stage (pT2: 77%, pT3a: 71%, pT3b/pN1: 28%).
  • Salvage prostatectomy success rates are comparable to de novo procedures, but historically high complication rates, particularly incontinence, have been noted.

    • Impact:

    • Salvage prostatectomy is a viable option for select patients with recurrent prostate cancer after radiotherapy.
    • Careful patient selection, considering general health, life expectancy, PSA levels, and initial tumor stage, is essential.
    • Despite technical challenges and potential morbidity (e.g., 50% incontinence rate), outcomes can be acceptable with appropriate indications.