Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer.

Abstract

A positive post-irradiation prostatic biopsy associated with an increasing prostate specific antigen level but no palpable evidence of local progression may identify a subgroup of patients who could be cured by salvage surgical therapy. Between 1967 and 1992, 132 patients underwent salvage surgery, including radical retropubic prostatectomy in 79, anterior exenteration in 38, total exenteration in 5 and bilateral pelvic lymphadenectomy only in 10. The 10-year cancer-specific survival rate in the prostatectomy group was 72%. Local control was equivalent among the surgical groups. Radical retropubic prostatectomy patients with negative surgical margins and nonaneuploid tumors demonstrated a significant survival advantage. Adjuvant hormonal therapy improved the disease-free survival rate in patients with nonaneuploid tumors. Radical retropubic prostatectomy can achieve excellent survival with low morbidity in select patients. Patients with clinical stage T2 or less disease and with prostate specific antigen detected cancers (52% and 75%, respectively) had pathological stage T2 disease. Thus, by using modern diagnostic techniques patients can be identified who may be cured with salvage surgery.