Abstract
To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa). From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year. Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy, the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months. SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life.
Highlights
According to estimates for 2008 from the Brazilian National Cancer Institute (INCA) 49,530 new cases of prostate cancer (PCa) are expected in Brazil (1)
When localized recurrence is confirmed during follow-up of these patients, we recommend hormone blockade via androgen ablation or salvage radical prostatectomy (SRP)
Between January 2005 and June 2007, we carried out a prospective study in which we evaluated patients in whom recurrent PCa was proven following external radiation therapy (RT) with more than 7,000 cGy as early management with intention to cure for a localized cancer in clinical Stages I and II
Summary
According to estimates for 2008 from the Brazilian National Cancer Institute (INCA) 49,530 new cases of prostate cancer (PCa) are expected in Brazil (1). More than 1,200 will be seen at our hospital. We have employed doses higher than 7,000 Gy in external beam radiation therapy (RT) to manage localized neoplasia. When localized recurrence is confirmed during follow-up of these patients, we recommend hormone blockade via androgen ablation or salvage radical prostatectomy (SRP). The first treatment method is considered palliative and the second is definitive with the intention to cure. When begun early in the course of recurrent disease, SRP allows excellent disease control without the need of concomitant hormonal treatment (2,3)
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