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Oncologic outcome and patterns of recurrence after salvage radical prostatectomy.
Eur Urol. 2009 Feb; 55(2):404-10.EU

Abstract

BACKGROUND

Limited data on patterns of recurrence (local or metastatic) after salvage radical prostatectomy (SP) is available.

OBJECTIVE

To examine biochemical, local and metastatic patterns of recurrence in patients undergoing SP for radiation-recurrent prostate cancer.

DESIGN, SETTING, AND PARTICIPANTS

146 patients with biopsy-proven local recurrence of prostate cancer after radiation therapy treated with SP were evaluated in a retrospective study at a single institution.

INTERVENTION

All patients underwent SP by mainly two surgeons.

MEASUREMENTS

Biochemical recurrence (BCR) after SP was defined as a serum prostate-specific antigen (PSA) level of >or=0.2 ng/ml or was defined by the initiation of androgen deprivation therapy. All predictors analyzed were determined after radiotherapy, before SP, and included PSA level, clinical stage, biopsy Gleason score, age at SP, and time interval from radiotherapy to SP.

RESULTS AND LIMITATIONS

Of the 146 patients treated with SP, 65 developed BCR. The median follow-up period for recurrence-free patients was 3.8 yr; 43 patients (29%) were followed for >5 yr. Overall, the 5-yr recurrence-free probability was 54% (95% CI, 44-63%). Clinical local recurrence occurred in only one patient who also had bone metastases. Overall, there were 16 prostate cancer-specific deaths and 19 deaths from other causes. The 5-yr cumulative incidence of death from prostate cancer was 4% (95% CI, 2-11%). Pre-SP serum PSA level and biopsy Gleason score were significantly associated with death due to prostate cancer (p<0.0005 and p=0.002, respectively). This study is retrospective and included carefully selected patients treated over a long period by, mainly, two experienced surgeons.

CONCLUSIONS

SP provides excellent local cancer control; only one patient in our series experienced a clinical local recurrence. Earlier identification of patients with persistent, viable local cancer despite radiation therapy will appropriately select patients for SP.

Authors+Show Affiliations

Division of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18639970

Citation

Paparel, Philippe, et al. "Oncologic Outcome and Patterns of Recurrence After Salvage Radical Prostatectomy." European Urology, vol. 55, no. 2, 2009, pp. 404-10.
Paparel P, Cronin AM, Savage C, et al. Oncologic outcome and patterns of recurrence after salvage radical prostatectomy. Eur Urol. 2009;55(2):404-10.
Paparel, P., Cronin, A. M., Savage, C., Scardino, P. T., & Eastham, J. A. (2009). Oncologic outcome and patterns of recurrence after salvage radical prostatectomy. European Urology, 55(2), 404-10. https://doi.org/10.1016/j.eururo.2008.07.007
Paparel P, et al. Oncologic Outcome and Patterns of Recurrence After Salvage Radical Prostatectomy. Eur Urol. 2009;55(2):404-10. PubMed PMID: 18639970.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Oncologic outcome and patterns of recurrence after salvage radical prostatectomy. AU - Paparel,Philippe, AU - Cronin,Angel M, AU - Savage,Caroline, AU - Scardino,Peter T, AU - Eastham,James A, Y1 - 2008/07/14/ PY - 2008/04/01/received PY - 2008/07/03/accepted PY - 2008/7/22/pubmed PY - 2009/9/26/medline PY - 2008/7/22/entrez SP - 404 EP - 10 JF - European urology JO - Eur Urol VL - 55 IS - 2 N2 - BACKGROUND: Limited data on patterns of recurrence (local or metastatic) after salvage radical prostatectomy (SP) is available. OBJECTIVE: To examine biochemical, local and metastatic patterns of recurrence in patients undergoing SP for radiation-recurrent prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: 146 patients with biopsy-proven local recurrence of prostate cancer after radiation therapy treated with SP were evaluated in a retrospective study at a single institution. INTERVENTION: All patients underwent SP by mainly two surgeons. MEASUREMENTS: Biochemical recurrence (BCR) after SP was defined as a serum prostate-specific antigen (PSA) level of >or=0.2 ng/ml or was defined by the initiation of androgen deprivation therapy. All predictors analyzed were determined after radiotherapy, before SP, and included PSA level, clinical stage, biopsy Gleason score, age at SP, and time interval from radiotherapy to SP. RESULTS AND LIMITATIONS: Of the 146 patients treated with SP, 65 developed BCR. The median follow-up period for recurrence-free patients was 3.8 yr; 43 patients (29%) were followed for >5 yr. Overall, the 5-yr recurrence-free probability was 54% (95% CI, 44-63%). Clinical local recurrence occurred in only one patient who also had bone metastases. Overall, there were 16 prostate cancer-specific deaths and 19 deaths from other causes. The 5-yr cumulative incidence of death from prostate cancer was 4% (95% CI, 2-11%). Pre-SP serum PSA level and biopsy Gleason score were significantly associated with death due to prostate cancer (p<0.0005 and p=0.002, respectively). This study is retrospective and included carefully selected patients treated over a long period by, mainly, two experienced surgeons. CONCLUSIONS: SP provides excellent local cancer control; only one patient in our series experienced a clinical local recurrence. Earlier identification of patients with persistent, viable local cancer despite radiation therapy will appropriately select patients for SP. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/18639970/Oncologic_outcome_and_patterns_of_recurrence_after_salvage_radical_prostatectomy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(08)00828-2 DB - PRIME DP - Unbound Medicine ER -