Oncologic outcome and patterns of recurrence after salvage radical prostatectomy

Limited data on patterns of recurrence (local or metastatic) after salvage radical prostatectomy (SP) is available.

To examine biochemical, local and metastatic patterns of recurrence in patients undergoing SP for radiation-recurrent prostate cancer.

146 patients with biopsy-proven local recurrence of prostate cancer after radiation therapy treated with SP were evaluated in a retrospective study at a single institution.

All patients underwent SP by mainly two surgeons.

Biochemical recurrence (BCR) after SP was defined as a serum prostate-specific antigen (PSA) level of >or=0.2 ng/ml or was defined by the initiation of androgen deprivation therapy. All predictors analyzed were determined after radiotherapy, before SP, and included PSA level, clinical stage, biopsy Gleason score, age at SP, and time interval from radiotherapy to SP.

Of the 146 patients treated with SP, 65 developed BCR. The median follow-up period for recurrence-free patients was 3.8 yr; 43 patients (29%) were followed for >5 yr. Overall, the 5-yr recurrence-free probability was 54% (95% CI, 44-63%). Clinical local recurrence occurred in only one patient who also had bone metastases. Overall, there were 16 prostate cancer-specific deaths and 19 deaths from other causes. The 5-yr cumulative incidence of death from prostate cancer was 4% (95% CI, 2-11%). Pre-SP serum PSA level and biopsy Gleason score were significantly associated with death due to prostate cancer (p<0.0005 and p=0.002, respectively). This study is retrospective and included carefully selected patients treated over a long period by, mainly, two experienced surgeons.

SP provides excellent local cancer control; only one patient in our series experienced a clinical local recurrence. Earlier identification of patients with persistent, viable local cancer despite radiation therapy will appropriately select patients for SP.