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Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review

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Abstract

Purpose

Salvage radical prostatectomy (sRP) represents a curative option for prostate cancer (PCa) biochemical recurrence (BCR) after radiation therapy (RT). In this review, we aimed to outline the contemporary results and use of sRP.

Methods

A web search was performed on the Ovid platform using Embase and Medline databases from January 2010 using pre-defined search terms. Web search was implemented by manual search. Oncological and functional outcomes and complications were summarized using standard classification systems, when feasible.

Results

sRP is currently underused, being chosen for radio-recurrent PCa treatment in around 1% of the cases. Surgery is complex due to radiation-induced tissue changes making posterior planes and apex dissection particularly challenging. Patient selection is paramount to maximize the oncological benefit. Most series report a BCR-free survival > 60%, mainly at the end of a short- to intermediate-term follow-up. Five-year progression-free survival is nearly 50% and 5-year cancer-specific survival rates are around 90%. Major peri-operative complications, anastomotic leaks and strictures, still more frequent than in a primary RP setting, have been steering towards more acceptable rates in recent years, when compared to historical series. Continence rates are widely variable, often in between 39 and 60%. Potency remains difficult to recover.

Conclusions

sRP represents a curative option with promising short- to medium-term oncological results and acceptable side effects, in high-volume institutions. In appropriately selected patients, the procedure should not be underused due to the fear of poor functional outcomes and/or complications. Prospective studies are needed to assess the long-term outcomes and to further refine patient selection criteria.

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Author information

Authors and Affiliations

  1. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, C.so Bramante 88/90, 10100, Turin, Italy

    Giorgio Calleris, Giancarlo Marra, Ettore Dalmasso, Marco Falcone, Marco Oderda, Francesco Soria & Paolo Gontero

  2. Clinica Urologica, Dipartimento di Scienze chirurgiche, oncologiche e gastroenterologiche, Università degli Studi di Padova, Padua, Italy

    Alessandro Morlacco

  3. Clinical and Experimental Oncology and Immunology, Università degli Studi di Padova, Padua, Italy

    Alessandro Morlacco

  4. Department of Urology, Institut Mutualiste Montsouris, Paris, France

    Rafael Sanchez-Salas

  5. Department of Urology, Mayo Clinic, Rochester, MN, USA

    Robert Jeffrey Karnes

Authors
  1. Giorgio Calleris
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  2. Giancarlo Marra
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  3. Ettore Dalmasso
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  4. Marco Falcone
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  5. Robert Jeffrey Karnes
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  6. Alessandro Morlacco
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  7. Marco Oderda
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  8. Rafael Sanchez-Salas
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  9. Francesco Soria
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  10. Paolo Gontero
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Contributions

GC, GM: protocol/project development, data collection or management, data analysis; manuscript writing. FS, ED: data collection or management, data analysis, manuscript writing. MO, MF, AM: manuscript writing. RJK: protocol/project development, manuscript review for important intellectual contents. PG: protocol/project development, manuscript editing, manuscript review for important intellectual contents.

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Correspondence to Giancarlo Marra.

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Calleris, G., Marra, G., Dalmasso, E. et al. Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. World J Urol 37, 1469–1483 (2019). https://doi.org/10.1007/s00345-019-02749-z

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  • DOI: https://doi.org/10.1007/s00345-019-02749-z

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