Role of salvage radical prostatectomy for recurrent prostate cancer after radiation therapy Journal Article

Authors: Stephenson, A. J.; Eastham, J. A.
Article Title: Role of salvage radical prostatectomy for recurrent prostate cancer after radiation therapy
Abstract: Patients with isolated local recurrence of prostate cancer after radiation therapy may potentially be cured of their disease by salvage radical prostatectomy (RP). The stage-specific 5-year cancer-control rates of salvage RP resemble those of standard RP. However, the ability to effectively administer salvage treatment to patients with radiorecurrent disease is compromised by the lack of diagnostic tests with sufficient sensitivity and specificity to detect local recurrence at an early stage while it is amenable to local salvage therapy. By the time biochemical recurrence is declared using the current American Society for Therapeutic Radiology and Oncology definition, the majority of patients have advanced local disease, precluding successful local salvage therapy. When salvage RP is performed at prostate-specific antigen levels of 10 ng/mL or less, an estimated 70% of patients are free of disease at 5 years. With better patient selection and technical modifications, the morbidity associated with salvage RP has improved substantially. Rates of urinary incontinence and anastomotic stricture are acceptable, although one third of patients will experience these complications. Salvage cryotherapy is a minimally invasive alternative to salvage RP, but cancer-control rates appear to be inferior and it does not provide a clear advantage over salvage RP in terms of reduced morbidity. Patients with local recurrence after radiation therapy are at increased risk of metastatic progression and cancer-specific mortality. Currently, salvage RP represents the only curative treatment option for these patients. Salvage RP may favorably alter the natural history of biochemical recurrence after radiation therapy, but it must be instituted early in the course of recurrent disease to be effective. © 2005 by American Society of Clinical Oncology.
Keywords: disease course; review; salvage therapy; united states; cancer radiotherapy; recurrent cancer; prostate specific antigen; protein blood level; metabolism; neoplasm recurrence, local; tumor markers, biological; tumor marker; prostate cancer; prostate-specific antigen; prostatic neoplasms; urine incontinence; prostatectomy; tumor recurrence; prostate tumor; medical society; brachytherapy; intermethod comparison; minimally invasive surgery; diagnostic test; cryotherapy; urethra stricture; sensitivity and sensibility
Journal Title: Journal of Clinical Oncology
Volume: 23
Issue: 32
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2005-11-10
Start Page: 8198
End Page: 8203
Language: English
DOI: 10.1200/jco.2005.03.1468
PUBMED: 16278473
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 58" - "Export Date: 24 October 2012" - "CODEN: JCOND" - "Source: Scopus"
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MSK Authors
  1. James Eastham
    492 Eastham