Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy Journal Article
| Authors: | Bianco, F. J. Jr; Scardino, P. T.; Stephenson, A. J.; Di Blasio, C. J.; Fearn, P. A.; Eastham, J. A. |
| Article Title: | Long-term oncologic results of salvage radical prostatectomy for locally recurrent prostate cancer after radiotherapy |
| Abstract: | Purpose: Salvage radical prostatectomy (RP) may potentially cure patients who have isolated local prostate cancer recurrence after radiotherapy (RT). We report the long-term cancer control associated with salvage RP in a consecutive cohort of patients and identify the variables associated with disease progression and cancer survival. Methods and Materials: A total of 100 consecutive patients underwent salvage RP with curative intent for biopsy-confirmed, locally recurrent, prostate cancer after RT. Disease progression after salvage RP was defined as a prostate-specific antigen (PSA) level of ≥0.2 ng/mL or by initiation of androgen deprivation therapy. Cancer-specific mortality was defined as active clinical disease progression despite castration. Cox regression analysis was used to evaluate these endpoints. The median follow-up from RT was 10 years (range, 3-27 years) and from salvage RP was 5 years (range, 1-20 years). Results: Overall, the 5-year progression-free probability was 55% (95% confidence interval, 46-64%), and the median progression-free interval was 6.4 years. The preoperative PSA level was the only significant pretreatment predictor of disease progression in the multivariate analysis (p = 0.01). The 5-year progression-free probability for patients with a preoperative PSA level of <4, 4-10, and >10 ng/mL was 86%, 55%, and 37%, respectively. The 10-year and 15-year cancer-specific mortality after salvage RP was 27% and 40%, respectively. The median time from disease progression to cancer-specific death was 10.3 years (95% confidence interval, 7.6-12.9). After multivariate analysis, the preoperative serum PSA level and seminal vesicle or lymph node status correlated independently with disease progression. Conclusions: Greater preoperative PSA levels are associated with disease progression and cancer-specific death. Long-term control of locally recurrent prostate cancer after definitive RT is possible when salvage RP is performed early in the course of recurrent disease. © 2005 Elsevier Inc. |
| Keywords: | survival; adult; cancer survival; controlled study; treatment outcome; aged; middle aged; major clinical study; mortality; cancer recurrence; salvage therapy; cancer growth; cancer risk; cancer radiotherapy; postoperative care; follow up; follow-up studies; preoperative evaluation; prostate specific antigen; neoplasm recurrence, local; radiotherapy; cohort analysis; pathology; oncology; risk assessment; prostate cancer; prostate-specific antigen; prostatic neoplasms; death; antigens; tumors; probability; prostatectomy; disease progression; psa; long term care; surgery; multivariate analysis; castration; patient treatment; disease control; regression analysis; analysis of variance; androgen therapy; prostate neoplasms; local prostate cancer; long-term cancer control; oncologic results; prostate specific antigens (psa); radical prostatectomy (rp) |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 62 |
| Issue: | 2 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2005-06-01 |
| Start Page: | 448 |
| End Page: | 453 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2004.09.049 |
| PUBMED: | 15890586 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 88" - "Export Date: 24 October 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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