Collaborative Review – Prostate CancerCancer Control and Functional Outcomes of Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer: A Systematic Review of the Literature
Introduction
The role of salvage radical prostatectomy (SRP) has evolved, with recent series showing improved results for the treatment of radiation-recurrent prostate cancer (PCa). Despite these reports, the vast majority of patients with radiation-recurrent PCa have been considered only for palliative systemic therapy [1]. Prior to the serum prostate-specific antigen (PSA) era, the difficulty of differentiating between local and distant recurrence as well as frequent surgical complications led to the exclusion of SRP from the management of radiation-recurrent PCa, except for a few referral centers. With the advent of improved patient selection and surgical technique, a different and promising scenario has been reported [2], [3], [4].
Currently, the majority of patients failing definitive radiation therapy (RT) for PCa are treated with androgen-deprivation therapy (ADT). However, most guidelines recommend SRP at experienced centers for a subset of patients with biochemical recurrence (BCR) not indicative of systemic relapse and studies negative for metastases [5], [6].
Because several confounding studies have addressed these issues over a long period of time and a comprehensive, updated review is currently lacking, we analyzed the currently available evidence concerning the main aspects of SRP: diagnosis, patient selection, predictive oncologic factors, surgical technique (open, laparoscopic, and robotic SRP), cancer control, surgical complications, and functional outcomes.
Section snippets
Evidence acquisition
A systematic literature review was performed in June 2011 using Medline, Embase, and Thomson-Reuters’ Web of Science. In the free-text protocol, the following terms were applied: salvage, radical, prostatectomy, radiorecurrent prostate cancer, and salvage therapy. The temporal limit was January 1980. Only English-language articles were considered for review. In addition, cited references from the selected articles and from review articles retrieved in the search were assessed for significant
Radiation-recurrent prostate cancer: definition and diagnosis
PCa recurrence after RT can be diagnosed by BCR or clinical evidence of disease, which usually occurs several years after BCR. BCR is defined by the American Society for Therapeutic Radiation and Oncology (ASTRO) as a rise in serum PSA by ≥2 ng/ml from a nadir PSA after RT and may represent either local or systemic disease recurrence [10]. Therefore, because this definition actually does not predict for local recurrence alone and instead predicts progression to metastatic disease and death from
Conclusions
Recurrent PCa represents a challenge for physicians, because currently available clinical and imaging tools poorly distinguish between local and distant failure. Managing patients with BCR after RT starts with an important treatment decision as to whether the patient is a candidate for further local therapy. Evidence supports that cancer control in a subset of patients with low-risk disease is more effective. Clinical predictors, such as PSA level and biopsy Gleason score, can be used to more
References (62)
- et al.
Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration
Eur Urol
(2011) - et al.
Prognostic parameters, complications, and oncologic and functional outcome of salvage radical prostatectomy for locally recurrent prostate cancer after 21st-century radiotherapy
Eur Urol
(2010) - et al.
Impact of prior prostate radiation on complications after radical prostatectomy
J Urol
(2010) - et al.
EAU guidelines on prostate cancer. Part II: treatment of advanced, relapsing, and castration-resistant prostate cancer
Eur Urol
(2011) - et al.
Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference
Int J Radiat Oncol Biol Phys
(2006) - et al.
External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study
Lancet Oncol
(2010) - et al.
PSA bounce and biochemical failure after brachytherapy for prostate cancer: a study of 820 patients with a minimum of 3 years of follow-up
Int J Radiat Oncol Biol Phys
(2011) - et al.
Potential and limitations of diffusion-weighted magnetic resonance imaging in kidney, prostate, and bladder cancer including pelvic lymph node staging: a critical analysis of the literature
Eur Urol
(2012) - et al.
Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels
J Urol
(1995) - et al.
Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer
J Urol
(2008)
Radical prostatectomy after definitive radiation therapy for prostate cancer
Urology
Salvage surgery plus androgen deprivation for radioresistant prostatic adenocarcinoma
J Urol
Radical prostatectomy and exenterative procedures for local failure after radiotherapy with curative intent: comparison of outcomes
J Urol
Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer
J Urol
Predictors for maximal outcome in patients undergoing salvage surgery for radio-recurrent prostate cancer
Urology
Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy
J Urol
Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy
Int J Radiat Oncol Biol Phys
Salvage surgery for radiorecurrent prostate cancer: contemporary outcomes
J Urol
Salvage radical prostatectomy for radiorecurrent prostate cancer: indications and results
Eur J Surg Oncol
Oncologic outcome and patterns of recurrence after salvage radical prostatectomy
Eur Urol
Robotic assisted laparoscopic salvage prostatectomy for radiation resistant prostate cancer
J Urol
Radical prostatectomy after radiation therapy for cancer of the prostate: feasibility and prognosis
J Urol
Radical prostatectomy after radiotherapy for prostatic cancer
J Urol
Salvage radical prostatectomy after failure of curative radiotherapy for adenocarcinoma of prostate
Urology
Total pelvic exenteration: effective palliation of perineal pain in patients with locally recurrent prostate cancer
J Urol
Initial results of salvage laparoscopic radical prostatectomy after radiation failure
J Urol
Successful salvage robotic-assisted radical prostatectomy after external beam radiotherapy failure
Urology
Salvage surgery following radical radiotherapy for adenocarcinoma of the prostate
J Urol
Salvage prostatectomy with continent catheterizable urinary reconstruction: a novel approach to recurrent prostate cancer after radiation therapy
J Urol
Salvage laparoscopic extraperitoneal radical prostatectomy after failed high-intensity focused ultrasound and radiotherapy for localized prostate cancer
Urology
Recovery of erectile function after salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy
Urology
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