Salvage Radical Prostatectomy for recurrent Prostate Cancer: Verification of EAU guideline criteria

OBJECTIVE: To analyze oncological and functional outcomes of salvage radical prostatectomy (SRP) in patients with recurrent prostate cancer (PCa) and to compare outcomes of patients within and outside the EAU guideline criteria (organ-confined PCa ≤ T2b, Gleason score ≤ 7 and preoperative PSA < 10 ng/mL) for SRP.

PATIENTS AND METHODS: A total of 55 patients who underwent SRP from January 2007 to December 2012 were retrospectively analyzed. Kaplan-Meier curves assessed time to biochemical recurrence (BCR), metastasis-free survival (MFS) and cancer specific survival (CSS). Cox regressions addressed factors influencing BCR and MFS. BCR was defined as PSA>0.2 ng/ml and rising, continence as the use of 0-1 safety pad per day and potency as an IIEF-5 score ≥18.

RESULTS: Median follow-up was 36 months. Following SRP 42.0% of the patients experienced BCR, 15.9% developed metastasis and 5.5% died from PCa. Patients fulfilling EAU guideline criteria were less likely to have positive lymph nodes and had significantly better BCR-free survival (5-year BCR-free survival 73.9% vs. 11.6% (p=0.001), respectively). In multivariate analysis, LDR-brachytherapy as primary treatment (p=0.03) and presence of positive lymph nodes at SRP (p=0.02) were significantly associated with worse BCR-free survival. The presence of positive lymph nodes or Gleason score > 7 at SRP were independently associated with metastasis. Urinary continence-rate 1 year after SRP was 74%. Seven patients (12.7%) experienced complications ≥III (Clavien grade).

CONCLUSION: Salvage radical prostatectomy is a safe procedure providing good cancer control and reasonable urinary continence. Oncologic outcomes are significantly better in patients who met EAU guideline recommendations. This article is protected by copyright. All rights reserved.