Predictors For Maximal Outcome in Patients Undergoing Salvage Surgery For Radio-Recurrent Prostate Cancer

• Published in: Urology (Ridgewood, N.J.) Vol. 51; no. 5; pp. 789 - 795
• Main Authors: Gheiler, Edward L, Tefilli, Marcos V, Tiguert, Rabi, Grignon, David, Cher, Michael L, Sakr, Wael, Pontes, J.Edson, Wood, David P
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.1998; Elsevier Science
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Aged; Biological and medical sciences; Disease Progression; Disease-Free Survival; Follow-Up Studies; Forecasting; Humans; Lymphatic Metastasis; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local - blood; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - radiotherapy; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Prognosis; Prostate-Specific Antigen - blood; Prostatectomy; Prostatic Neoplasms - blood; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Remission Induction; Retrospective Studies; Salvage Therapy; Seminal Vesicles - pathology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Treatment Failure; Treatment Outcome; Adenocarcinoma; Human; Relapse; Urinary system disease; Prostate disease; Palliative treatment; Malignant tumor; Radiotherapy; Statistical study; Survival; Clinical stage; Treatment; Surgery; Complication; Evolution; Prostatectomy; Predictive factor; Localization; Male genital diseases; Prostate
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/S0090-4295(98)00096-X

Objectives. To determine preradiation and preoperative clinical staging and postoperative pathologic factors that can predict disease-free survival in patients undergoing salvage surgery for radio-recurrent prostate cancer. Methods. A retrospective review was performed on 40 patients who underwent salvage surgery for radio-recurrent prostate cancer. Preradiation and preoperative clinical staging factors, as well as pathologic stage were analyzed as predictors of disease-free survival. Biochemical failure was defined as a persistent serum prostate-specific antigen (PSA) elevation greater than 0.4 ng/mL. Results. As a group, salvage surgery provided excellent clinical disease control in 35 of 40 patients (87.5%). Overall, 18 of 38 (47.4%) patients analyzed had no evidence of biochemical progression. Preradiation clinical stage and pathologically organ-confined disease were statistically significant predictors of disease-free survival ( P = 0.03 and P = 0.02, respectively). Seminal vesicle invasion and positive lymph nodes were the worst pathologic prognostic factors. Preoperative clinical T1c disease approached statistical significance in predicting pathologically organ-confined disease and disease-free survival ( P = 0.08 and P = 0.07, respectively). Conclusions. Ideal candidates for salvage surgery should have preradiation and preoperative clinically organ-confined disease. All patients with pathologically organ-confined disease following salvage prostatectomy were disease free at a mean follow-up of 36.1 months. Salvage surgery, although technically feasible, should not be widely advocated as an effective curative treatment in patients with locally advanced disease at the time of diagnosis.