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Radical Prostatectomy pp 141–156Cite as

Open Salvage Radical Prostatectomy for Recurrence of Prostate Cancer after Radiation Therapy

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Abstract

There are a number of treatment options for men with local recurrence of prostate cancer after radiation therapy (RT). While technically challenging, salvage radical prostatectomy (RP) provides excellent local control and can eradicate the disease in a high proportion of patients whose cancer is confined to the prostate or immediate periprostatic tissue. Patient considering salvage RP should be in excellent health with a life expectancy of at least 10 years. Patients should have no evidence of distant metastatic disease and no evidence of lymph node involvement before or after RT. The cancer (whether initial or recurrent) should be clinically organ-confined and potentially curable. Serum prostate-specific antigen (PSA) level and biopsy Gleason score before salvage RP are significantly associated with death from prostate cancer. As with standard RP, patient selection is of utmost importance in planning appropriate treatment.

Salvage RP is technically feasible using current surgical techniques with satisfactory immediate intraoperative and postoperative outcomes. The majority of patients can be treated via a retropubic approach. Short-term and long-term complications are more common after salvage RP than standard RP, partly because the normal anatomic planes are lost as a consequence of RT. The most significant late complications include development of an anastomotic stricture and/or persistent urinary incontinence. This chapter highlights the technique of open salvage RP emphasizing an anatomical approach that has been adapted over time to maximize safe removal of the entire cancer while minimizing the potential for intraoperative and postoperative complications.

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Abbreviations

DVC:

Dorsal vein complex

NVB:

Neurovascular bundle

PCNA:

Proliferative cell nuclear antigen

PLND:

Pelvic lymph node dissection

PSA:

Prostate-specific antigen

RP:

Radical prostatectomy

RT:

Radiation therapy

References

  1. Djavan B, Moul JW, Zlotta A, Remzi M, Ravery V. PSA progression following radical prostatectomy and radiation therapy: new standards in the new Millennium. Eur Urol. 2003;43(1):12–27.

    Article  PubMed  Google Scholar 

  2. Darwish OM, Raj GV. Management of biochemical recurrence after primary localized therapy for prostate cancer. Front Oncol. 2012;2:48.

    Article  PubMed  Google Scholar 

  3. Kaplan ID, Prestidge BR, Bagshaw MA, Cox RS. The importance of local control in the treatment of prostatic cancer. J Urol. 1992;147(3 Pt 2):917–21.

    PubMed  CAS  Google Scholar 

  4. Zelefsky MJ, Shi W, Yamada Y, Kollmeier MA, Cox B, Park J, et al. Postradiotherapy 2-year prostate-specific antigen nadir as a predictor of long-term prostate cancer mortality. Int J Radiat Oncol Biol Phys. 2009;75(5):1350–6.

    Article  PubMed  Google Scholar 

  5. Chade DC, Shariat SF, Cronin AM, Savage CJ, Karnes RJ, Blute ML, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. Eur Urol. 2011;60(2):205–10.

    Article  PubMed  Google Scholar 

  6. Chade DC, Eastham J, Graefen M, Hu JC, Karnes RJ, Klotz L, et al. Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol. 2012;61(5):961–71.

    Article  PubMed  Google Scholar 

  7. Rogers E, Ohori M, Kassabian VS, Wheeler TM, Scardino PT. Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels. J Urol. 1995;153(1):104–10.

    Article  PubMed  CAS  Google Scholar 

  8. Paparel P, Cronin AM, Savage C, Scardino PT, Eastham JA. Oncologic outcome and patterns of recurrence after salvage radical prostatectomy. Eur Urol. 2009;55(2):404–10.

    Article  PubMed  Google Scholar 

  9. Heidenreich A, Richter S, Thuer D, Pfister D. Prognostic parameters, complications, and oncologic and functional outcome of salvage radical prostatectomy for locally recurrent prostate cancer after 21st-century radiotherapy. Eur Urol. 2010;57(3):437–43.

    Article  PubMed  Google Scholar 

  10. Crook JM, Perry GA, Robertson S, Esche BA. Routine prostate biopsies following radiotherapy for prostate cancer: results for 226 patients. Urology. 1995;45(4):624–31. discussion 631–632.

    Article  PubMed  CAS  Google Scholar 

  11. Arrayeh E, Westphalen AC, Kurhanewicz J, Roach III M, Jung AJ, Carroll PR, et al. Does local recurrence of prostate cancer after radiation therapy occur at the site of primary tumor? Results of a longitudinal MRI and MRSI study. Int J Radiat Oncol Biol Phys. 2012;82(5):e787–93.

    Article  PubMed  Google Scholar 

  12. Bostwick DG, Egbert BM, Fajardo LF. Radiation injury of the normal and neoplastic prostate. Am J Surg Pathol. 1982;6(6):541–51.

    Article  PubMed  CAS  Google Scholar 

  13. Gaudin PB, Zelefsky MJ, Leibel SA, Fuks Z, Reuter VE. Histopathologic effects of three-dimensional conformal external beam radiation therapy on benign and malignant prostate tissues. Am J Surg Pathol. 1999;23(9):1021–31.

    Article  PubMed  CAS  Google Scholar 

  14. Crook JM, Bahadur YA, Robertson SJ, Perry GA, Esche BA. Evaluation of radiation effect, tumor differentiation, and prostate specific antigen staining in sequential prostate biopsies after external beam radiotherapy for patients with prostate carcinoma. Cancer. 1997;79(1):81–9.

    Article  PubMed  CAS  Google Scholar 

  15. Stephenson AJ, Scardino PT, Bianco Jr FJ, DiBlasio CJ, Fearn PA, Eastham JA. Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy. J Urol. 2004;172(6 Pt 1):2239–43.

    Article  PubMed  Google Scholar 

  16. Vallancien G, Gupta R, Cathelineau X, Baumert H, Rozet F. Initial results of salvage laparoscopic radical prostatectomy after radiation failure. J Urol. 2003;170(5):1838–40.

    Article  PubMed  Google Scholar 

  17. Boris RS, Bhandari A, Krane LS, Eun D, Kaul S, Peabody JO. Salvage robotic-assisted radical prostatectomy: initial results and early report of outcomes. BJU Int. 2009;103(7):952–6.

    Article  PubMed  CAS  Google Scholar 

  18. Nunez-Mora C, Garcia-Mediero JM, Cabrera-Castillo PM. Radical laparoscopic salvage prostatectomy: medium-term functional and oncological results. J Endourol. 2009;23(8):1301–5.

    Article  PubMed  Google Scholar 

  19. Zugor V, Labanaris AP, Porres D, Heidenreich A, Witt JH. Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes. Vanderbilt paper. J Urol 2013. Aug. 31, http/pubmed/24008772.

  20. Nguyen PL, D'Amico AV, Lee AK, Suh WW. Patient selection, cancer control, and complications after salvage local therapy for postradiation prostate-specific antigen failure: a systematic review of the literature. Cancer. 2007;110(7):1417–28.

    Article  PubMed  Google Scholar 

  21. Bader P, Burkhard FC, Markwalder R, Studer UE. Is a limited lymph node dissection an adequate staging procedure for prostate cancer? J Urol. 2002;168(2):514–8. discussion 8.

    Article  PubMed  Google Scholar 

  22. Briganti A, Blute ML, Eastham JH, Graefen M, Heidenreich A, Karnes JR, et al. Pelvic lymph node dissection in prostate cancer. Eur Urol. 2009;55(6):1251–65.

    Article  PubMed  Google Scholar 

  23. Touijer K, Rabbani F, Otero JR, Secin FP, Eastham JA, Scardino PT, et al. Standard versus limited pelvic lymph node dissection for prostate cancer in patients with a predicted probability of nodal metastasis greater than 1%. J Urol. 2007;178(1):120–4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Ketttering Cancer Center, 353 East 68th Street, Suite 617B, New York, NY, 10021, USA

    James A. Eastham M.D.

Authors
  1. James A. Eastham M.D.
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Correspondence to James A. Eastham M.D. .

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Editors and Affiliations

  1. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, New York, USA

    James A. Eastham

  2. Brady Urological Institute, Johns Hopkins Medical Institution, Baltimore, Maryland, USA

    Edward M. Schaeffer

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Eastham, J.A. (2014). Open Salvage Radical Prostatectomy for Recurrence of Prostate Cancer after Radiation Therapy. In: Eastham, J., Schaeffer, E. (eds) Radical Prostatectomy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8693-0_9

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  • DOI: https://doi.org/10.1007/978-1-4614-8693-0_9

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-8692-3

  • Online ISBN: 978-1-4614-8693-0

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