|Title: ||Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration|
|Authors: ||Chade, Daher C ×|
Shariat, Shahrokh F
Cronin, Angel M
Savage, Caroline J
Karnes, R Jeffrey
Blute, Michael L
van der Poel, Henk G
Van Poppel, Hendrik
Gleave, Martin E
Scardino, Peter T
Eastham, James A #
|Issue Date: ||Aug-2011 |
|Publisher: ||Elsevier Science|
|Series Title: ||European Urology vol:60 issue:2 pages:205-210|
|Abstract: ||BACKGROUND: Oncologic outcomes in men with radiation-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) are poorly defined.
OBJECTIVE: To identify predictors of biochemical recurrence (BCR), metastasis, and death following SRP to help select patients who may benefit from SRP.
DESIGN, SETTING, AND PARTICIPANTS: This is a retrospective, international, multi-institutional cohort analysis. There was a median follow-up of 4.4 yr following SRP performed on 404 men with radiation-recurrent PCa from 1985 to 2009 in tertiary centers.
INTERVENTION: Open SRP.
MEASUREMENTS: BCR after SRP was defined as a serum prostate-specific antigen (PSA) ≥ 0.1 or ≥ 0.2 ng/ml (depending on the institution). Secondary end points included progression to metastasis and cancer-specific death.
RESULTS AND LIMITATIONS: Median age at SRP was 65 yr of age, and median pre-SRP PSA was 4.5 ng/ml. Following SRP, 195 patients experienced BCR, 64 developed metastases, and 40 died from PCa. At 10 yr after SRP, BCR-free survival, metastasis-free survival, and cancer-specific survival (CSS) probabilities were 37% (95% confidence interval [CI], 31-43), 77% (95% CI, 71-82), and 83% (95% CI, 76-88), respectively. On preoperative multivariable analysis, pre-SRP PSA and Gleason score at postradiation prostate biopsy predicted BCR (p = 0.022; global p < 0.001) and metastasis (p = 0.022; global p < 0.001). On postoperative multivariable analysis, pre-SRP PSA and pathologic Gleason score at SRP predicted BCR (p = 0.014; global p < 0.001) and metastasis (p < 0.001; global p < 0.001). Lymph node involvement (LNI) also predicted metastasis (p = 0.017). The main limitations of this study are its retrospective design and the follow-up period.
CONCLUSIONS: In a select group of patients who underwent SRP for radiation-recurrent PCa, freedom from clinical metastasis was observed in >75% of patients 10 yr after surgery. Patients with lower pre-SRP PSA levels and lower postradiation prostate biopsy Gleason score have the highest probability of cure from SRP.
|Publication status: ||published|
|KU Leuven publication type: ||IT|
|Appears in Collections:||Urology Section (-)|