Salvage radical prostatectomy for radiation-recurrent prostate cancer: A multi-institutional collaboration Journal Article

Authors: Chade, D. C.; Shariat, S. F.; Cronin, A. M.; Savage, C. J.; Karnes, R. J.; Blute, M. L.; Briganti, A.; Montorsi, F.; Van Der Poel, H. G.; Van Poppel, H.; Joniau, S.; Godoy, G.; Hurtado-Coll, A.; Gleave, M. E.; Dall'Oglio, M.; Srougi, M.; Scardino, P. T.; Eastham, J. A.
Article Title: Salvage radical prostatectomy for radiation-recurrent prostate cancer: A multi-institutional collaboration
Abstract: Background: Oncologic outcomes in men with radiation-recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP) are poorly defined. Objective: To identify predictors of biochemical recurrence (BCR), metastasis, and death following SRP to help select patients who may benefit from SRP. Design, setting, and participants: This is a retrospective, international, multi-institutional cohort analysis. There was a median follow-up of 4.4 yr following SRP performed on 404 men with radiation-recurrent PCa from 1985 to 2009 in tertiary centers. Intervention: Open SRP. Measurements: BCR after SRP was defined as a serum prostate-specific antigen (PSA) ≥0.1 or ≥0.2 ng/ml (depending on the institution). Secondary end points included progression to metastasis and cancer-specific death. Results and limitations: Median age at SRP was 65 yr of age, and median pre-SRP PSA was 4.5 ng/ml. Following SRP, 195 patients experienced BCR, 64 developed metastases, and 40 died from PCa. At 10 yr after SRP, BCR-free survival, metastasis-free survival, and cancer-specific survival (CSS) probabilities were 37% (95% confidence interval [CI], 31-43), 77% (95% CI, 71-82), and 83% (95% CI, 76-88), respectively. On preoperative multivariable analysis, pre-SRP PSA and Gleason score at postradiation prostate biopsy predicted BCR (p = 0.022; global p < 0.001) and metastasis (p = 0.022; global p < 0.001). On postoperative multivariable analysis, pre-SRP PSA and pathologic Gleason score at SRP predicted BCR (p = 0.014; global p < 0.001) and metastasis (p < 0.001; global p < 0.001). Lymph node involvement (LNI) also predicted metastasis (p = 0.017). The main limitations of this study are its retrospective design and the follow-up period. Conclusions: In a select group of patients who underwent SRP for radiation-recurrent PCa, freedom from clinical metastasis was observed in >75% of patients 10 yr after surgery. Patients with lower pre-SRP PSA levels and lower postradiation prostate biopsy Gleason score have the highest probability of cure from SRP. © 2011 European Association of Urology.
Keywords: adult; aged; major clinical study; cancer recurrence; postoperative period; salvage therapy; cancer growth; disease free survival; follow up; prostate specific antigen; metastasis; prostate cancer; gleason score; death; preoperative period; prostatectomy; prostate biopsy; radiation therapy; tertiary health care; cancer control
Journal Title: European Urology
Volume: 60
Issue: 2
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2011-08-01
Start Page: 205
End Page: 210
Language: English
DOI: 10.1016/j.eururo.2011.03.011
PROVIDER: scopus
PMCID: PMC3124574
PUBMED: 21420229
Notes: --- - "Export Date: 17 August 2011" - "CODEN: EUURA" - "Source: Scopus"
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MSK Authors
  1. Caroline Savage
    80 Savage
  2. Peter T Scardino
    621 Scardino
  3. Daher Chade
    19 Chade
  4. Shahrokh Shariat
    67 Shariat
  5. Angel M Cronin
    145 Cronin
  6. James Eastham
    426 Eastham
  7. Guilherme Godoy
    23 Godoy