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Salvage Radical Prostatectomy in Nonmetastatic Castration-Resistant Prostate Cancer.

Gastón López-Fontana1, Juan Manuel Guglielmi1, Rodrigo López-Fontana1

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Summary

Salvage laparoscopic radical prostatectomy (sLRP) shows promising short-term oncological outcomes for men with castration-resistant prostate cancer (CRPC M0) after radiation therapy. Four of five patients achieved undetectable PSA levels post-surgery.

Keywords:
castration-resistant prostate cancerprostate cancerradiotherapysalvage radical prostatectomy

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Area of Science:

  • Urology
  • Oncology
  • Surgical Innovation

Background:

  • Metastasis-free castration-resistant prostate cancer (CRPC M0) after primary radiation therapy (pRT) presents a treatment challenge.
  • Salvage radical prostatectomy (sRP) is an option for select patients, with laparoscopic approaches (sLRP) offering potential benefits.

Purpose of the Study:

  • To analyze perioperative and short-term oncological outcomes of salvage laparoscopic radical prostatectomy (sLRP) in patients with CRPC M0 post-pRT.
  • To review current evidence on sRP for CRPC M0.

Main Methods:

  • Prospective analysis of perioperative and oncological outcomes in 5 patients with CRPC M0 after pRT who underwent sLRP.
  • Inclusion criteria: prior pRT, CRPC M0 on standard imaging and choline positron emission tomography MRI.
  • Literature review of PUBMED database.

Main Results:

  • No surgical complications or blood transfusions were reported.
  • Two patients experienced bladder neck contracture (Clavien IIIb), requiring endoscopic urethrotomy.
  • Pathological findings: T3 or higher, multifocal disease with 3 positive surgical margins.
  • Four of five patients achieved undetectable PSA post-sLRP; one remained on androgen deprivation therapy (ADT) without progression.
  • At 12 months follow-up, 4 patients had undetectable PSA, and one had stable disease on ADT.
  • Literature review indicated a 68.7% biochemical recurrence rate for CRPC M0 treated with sRP (open, laparoscopic, or robotic), with 17.4% disease-free at 4 years.

Conclusions:

  • Salvage laparoscopic radical prostatectomy (sLRP) demonstrated favorable short-term oncological control in this small series, with 4 of 5 patients disease-free at 12 months.
  • Current evidence for sRP in CRPC M0 is limited to retrospective, small-cohort studies with intermediate follow-up.
  • Further research with larger patient cohorts and longer follow-up is necessary to establish sLRP as a definitive treatment for CRPC M0.