BERKELEY, CA (UroToday.com) - In patients following primary radiotherapy or cryotherapy for prostate cancer (CaP) with a PSA recurrence and negative metastatic evaluation suggesting a local recurrence, salvage prostatectomy is an option to consider.
A group of investigators at Memorial Sloan-Kettering Cancer Center report on the use of salvage laparoscopic radical prostatectomy (sLRP) from 2004 and 2010 in patients failing primary radiotherapy or cryotherapy.
Fifteen patients were identified, 8 having had radiotherapy, 6 brachytherapy. and 1 cryotherapy. The median interval between primary therapy and biochemical recurrence (BCR) was 46 months and the median PSA nadir after primary therapy was 1.33ng/ml. Median PSA at the time of sLRP was 3.49ng/ml. sLRP was conventional in 11 patients and robot-assisted in 4 men. There were no conversions to open RP, and median operative time was 235 minutes. Median blood loss was 200ml and no patient received a blood transfusion. There were no perioperative deaths. One patient had a rectal injury repaired intraoperatively with a temporary diverting colostomy. There were 5 minor medical complications and no grade 3 or higher Clavien scale complications. There was one anastomotic leak successfully treated with an indwelling Foley catheter for 30 days. Median hospital stay was 2 days and urethral catheterization was on average 15 days. Pathologic stage was pT2a in 3 men, pT2b in 3 men, pT3a in 4 men, pT3b in 3 patients and pT4 in 2 patients. Only the two pT4 patients had positive surgical margins and two patients had lymph node metastasis. Three patients had a BCR; one had positive lymph nodes, one pT3a disease and one a positive surgical margin. Seven of 15 were continent at a median time of 8.4 months. One patient required implantation of an artificial urinary sphincter, and 7 patients required 1-2 pads per day. Only one of 5 potent patients preoperatively reported erections postoperatively.
Ahallal Y, Shariat SF, Chade DC, Mazzola C, Reuter VE, Sandhu JS, Laudone VP, Touijer KA, Guillonneau BD
BJU Int. 2010 Dec 16. Epub ahead of print.
10.1111/j.1464-410X.2010.09924.x
PubMed Abstract
PMID: 21166755