Salvage therapy for locally recurrent prostate cancer after external beam radiotherapy Journal Article


Authors: Stephenson, A. J.; Scardino, P. T.; Bianco, F. J. Jr; Eastham, J. A.
Article Title: Salvage therapy for locally recurrent prostate cancer after external beam radiotherapy
Abstract: The greatest obstacle in the cure of patients with locally recurrent prostate cancer after radiation therapy is the lack of early detection markers. The majority of patients who are candidates for local salvage therapy have locally advanced disease, precluding successful salvage therapy. A low pretreatment prostate specific antigen (PSA) has shown to be a favorable prognostic variable for disease progression, regardless of the specific local salvage therapy used. Of all the local salvage treatment options for these patients, we believe that salvage radical prostatectomy (RP) offers patients the greatest likelihood of a cure. The salvage RP results approach those achieved with standard RP for patients of similar pathologic stage. When patients are treated early in the course of recurrent disease (preoperative PSA < 10 ng/mL), an estimated two-thirds of patients will be disease-free 5 years after salvage RP alone. With better patient selection and continued technical modifications, the morbidity associated with salvage RP has substantially improved. Perioperative complications approach those observed with standard RP and approximately two-thirds of patients will recover urinary continence. Select patients may also recover functional erections when nerve-sparing techniques are used. Salvage cryotherapy and brachytherapy are minimally invasive alternatives to salvage RP. The cancer control results of these procedures appear to be inferior to results achieved with salvage RP. Each of these procedures is associated with significant morbidity and do not appear to provide a clear advantage over salvage RP in terms of posttreatment complications, urinary continence, and erectile function. A long-term cure is possible for patients with locally recurrent prostate cancer after radiation therapy. Local salvage therapy must be instituted early to be successful in the course of progressive disease. Copyright © 2004 by Current Science Inc.
Keywords: adult; aged; middle aged; surgical technique; disease course; review; cancer localization; cancer recurrence; salvage therapy; patient selection; cancer staging; preoperative evaluation; biological marker; prostate specific antigen; neoplasm recurrence, local; morbidity; prostate cancer; prostate-specific antigen; prostatic neoplasms; early diagnosis; urine incontinence; prostatectomy; cystectomy; brachytherapy; perioperative period; radiation beam; cancer control; erectile dysfunction; cryotherapy; beam therapy; humans; prognosis; human; male
Journal Title: Current Treatment Options in Oncology
Volume: 5
Issue: 5
ISSN: 1527-2729
Publisher: Springer  
Date Published: 2004-10-01
Start Page: 357
End Page: 365
Language: English
PROVIDER: scopus
PUBMED: 15341674
DOI: 10.1007/s11864-004-0026-2
DOI/URL:
Notes: Curr. Treat. Options Oncol. -- Cited By (since 1996):29 -- Export Date: 16 June 2014 -- CODEN: CTOOB C2 - 15341674 -- Source: Scopus
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MSK Authors
  1. Peter T Scardino
    656 Scardino
  2. James Eastham
    492 Eastham
  3. Fernando J Bianco
    72 Bianco