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Perineal salvage prostatectomy for radiation resistant prostate cancer.
Eur Urol. 2007 Jun; 51(6):1565-71; discussion 1572.EU

Abstract

OBJECTIVES

No data are available on the use of perineal prostatectomy for salvage treatment of local recurrent prostate cancer after radiotherapy. Here we report on the clinical aspects and follow-up of salvage perineal prostatectomy.

MATERIALS AND METHODS

Twenty-seven patients underwent a perineal salvage prostatectomy from 1997-2005 for biopsy-proven local recurrent prostate cancer after external beam (n=22) or brachyradiotherapy (n=5). Staging included physical examination, prostate-specific antigen (PSA), transrectal ultrasound, computed tomography scan, and bone scan.

RESULTS

Mean PSA before surgery was 8.6 ng/ml (+/-2.8 ng/ml). Comparing clinical staging with final pathologic staging after salvage perineal prostatectomy showed a 67% clinical understaging. Mean blood loss was 677 cc, and perioperative morbidity consisted of prolonged anastomotic leakage (n=8), urosepsis (n=3), prolonged hematuria (n=3), urinary retention (n=2), and rectal perforation (n=1). One patient died during the postoperative course because of urosepsis and endocarditis. At an interval of at least 12 mo after surgery, 37% (10 of 27) and 7% (2 of 27) of patients reported normal continence and erectile function, respectively. Five patients died during a mean follow-up of 43 mo; two patients died of prostate cancer. Five-year biochemical recurrence-free survival was 31% (95%CI, 25-42%). In a multivariate Cox regression analysis the serum PSA and PSA doubling time (PSADT) at the time of surgery were the best predictors of biochemical recurrence-free survival. No patient with a PSA>2 ng/ml and a PSADT<12 mo was without biochemical recurrence 2 yr after surgery.

CONCLUSIONS

Salvage perineal prostatectomy showed functional results that favorably compare with the retropubic approach, but considerable morbidity is still frequent. Proper patient selection therefore is mandatory. A serum PSA level of >2 ng/ml and PSADT<12 mo independently predict shorter biochemical recurrence-free survival.

Authors+Show Affiliations

Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. h.vd.poel@nki.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16949728

Citation

van der Poel, Henk G., et al. "Perineal Salvage Prostatectomy for Radiation Resistant Prostate Cancer." European Urology, vol. 51, no. 6, 2007, pp. 1565-71; discussion 1572.
van der Poel HG, Beetsma DB, van Boven H, et al. Perineal salvage prostatectomy for radiation resistant prostate cancer. Eur Urol. 2007;51(6):1565-71; discussion 1572.
van der Poel, H. G., Beetsma, D. B., van Boven, H., & Horenblas, S. (2007). Perineal salvage prostatectomy for radiation resistant prostate cancer. European Urology, 51(6), 1565-71; discussion 1572.
van der Poel HG, et al. Perineal Salvage Prostatectomy for Radiation Resistant Prostate Cancer. Eur Urol. 2007;51(6):1565-71; discussion 1572. PubMed PMID: 16949728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perineal salvage prostatectomy for radiation resistant prostate cancer. AU - van der Poel,Henk G, AU - Beetsma,Daan B, AU - van Boven,Hester, AU - Horenblas,Simon, Y1 - 2006/08/24/ PY - 2006/06/01/received PY - 2006/08/08/accepted PY - 2006/9/5/pubmed PY - 2007/8/1/medline PY - 2006/9/5/entrez SP - 1565-71; discussion 1572 JF - European urology JO - Eur Urol VL - 51 IS - 6 N2 - OBJECTIVES: No data are available on the use of perineal prostatectomy for salvage treatment of local recurrent prostate cancer after radiotherapy. Here we report on the clinical aspects and follow-up of salvage perineal prostatectomy. MATERIALS AND METHODS: Twenty-seven patients underwent a perineal salvage prostatectomy from 1997-2005 for biopsy-proven local recurrent prostate cancer after external beam (n=22) or brachyradiotherapy (n=5). Staging included physical examination, prostate-specific antigen (PSA), transrectal ultrasound, computed tomography scan, and bone scan. RESULTS: Mean PSA before surgery was 8.6 ng/ml (+/-2.8 ng/ml). Comparing clinical staging with final pathologic staging after salvage perineal prostatectomy showed a 67% clinical understaging. Mean blood loss was 677 cc, and perioperative morbidity consisted of prolonged anastomotic leakage (n=8), urosepsis (n=3), prolonged hematuria (n=3), urinary retention (n=2), and rectal perforation (n=1). One patient died during the postoperative course because of urosepsis and endocarditis. At an interval of at least 12 mo after surgery, 37% (10 of 27) and 7% (2 of 27) of patients reported normal continence and erectile function, respectively. Five patients died during a mean follow-up of 43 mo; two patients died of prostate cancer. Five-year biochemical recurrence-free survival was 31% (95%CI, 25-42%). In a multivariate Cox regression analysis the serum PSA and PSA doubling time (PSADT) at the time of surgery were the best predictors of biochemical recurrence-free survival. No patient with a PSA>2 ng/ml and a PSADT<12 mo was without biochemical recurrence 2 yr after surgery. CONCLUSIONS: Salvage perineal prostatectomy showed functional results that favorably compare with the retropubic approach, but considerable morbidity is still frequent. Proper patient selection therefore is mandatory. A serum PSA level of >2 ng/ml and PSADT<12 mo independently predict shorter biochemical recurrence-free survival. SN - 0302-2838 UR - https://www.unboundmedicine.com/medline/citation/16949728/Perineal_salvage_prostatectomy_for_radiation_resistant_prostate_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(06)00935-3 DB - PRIME DP - Unbound Medicine ER -