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ESOU18: Salvage Radical Prostatectomy – Robotic

Amsterdam, The Netherlands (UroToday.com) The median time from biochemical recurrence (BCR) in prostate cancer (PC) to development of metastasis is between 3 and 7 years. After radiotherapy (RT) local recurrence rates range between 10-55%, depending on the RT dose given and whether the disease was high risk or not.  The PSA nadir can predict the risk of metastasis. An early (less than 6 months) high PSA (>2 ng/ml) predicts development of metastasis.

Salvage radical prostatectomy (SRP) after failure of RT was first described in 1985. Seven cases were reported with a mean of 5.3 units of blood infused and 2/7 patients had sustained a rectal injury. In 2011 a multi-institutional study was published encompassing 404 patients from 7 institutions between 1985 and 2009.1 The results showed rectal injuries occurring in 2-19% of open cases and 0-9% of minimally invasive cases. Urinary incontinence rates were not different between both surgical modalities (21-100% vs. 33-80%). A total of 70% and 75% of the patients were BCR and metastasis free, respectively, at 10 years follow-up. There have been some studies that have examined the utilization of the robotic approach for SRP, showing overall good results, with lower percentages of rectal injuries, but similar BCR rates.

The BCR free rate is quite similar after cryotherapy, brachytherapy or SRP for RT failure. However, the stricture and incontinence rates are higher for the SRP modality. It is important to note that low volume disease has significantly lower BCR free rates than high volume disease. The European Association of Urology (EAU) recommend using SRP for patients that initially had a T2b disease or lower, a Gleason score of 7 or below, and a PSA of less than 10 ng/ml.

In summary, selection of the appropriate patients for SRP is crucial. The BCR rates for SRP are non-inferior when compared to ablative techniques. Lastly, incontinence after SRP is quite considerable and patients should be aware of this.


Speaker: Henk van der Poel, MD, PhD, Board of the Dutch Urological Association and the European Association of Urology, Editor-in-Chief of the Netherlands Journal of Urology Amsterdam, The Netherlands

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands

References:

1. Chade DC, Shariat SF, Cronin AM, et al. Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. European urology 2011; 60(2): 205-10.