Postradiation radical prostatectomy associated with good survival rates
Salvage radical prostatectomy (SRP) after radiation produces good long-term survival rates in men with prostate adenocarcinoma, according to a recent study.
Ten-year overall survival (OS) of men who underwent SRP after radiation was 77.5 percent, while 20-year OS was 37.3 percent. The cancer-specific survival (CSS) rates were 88.6 and 72.7 percent at 10 and 20 years, respectively. [Clin Genitourin Cancer 2015;doi:10.1016/j.clgc.2015.12.010]
Ten-year OS did not differ between men who did or did not undergo pelvic lymph node dissection (PLND) (80 vs 76 percent; p=0.7 for OS). Number of nodes removed also did not affect OS and CSS.
However, after adjusting for age, race, disease grade and stage, and PLND status, men who underwent PLND had a significantly improved CSS (hazard ratio [HR], 2.7, 95 percent CI, 1.2-5.9; p=0.01 for non-PLND group).
“Good long-term survival can be achieved with SRP following radiation therapy. PLND does not affect the OS but significantly improves CSS. This study supports PLND at the time of salvage prostatectomy,” said the study authors, who recommended large, prospective studies to establish the impact of PLND in this group of patients.
Study participants were 364 prostate adenocarcinoma patients aged 40-75 who underwent SRP after radiation between 1988 and 2010. Data was obtained from the Surveillance, Epidemiology, and End Results (SEER) 18 registry.
In the past, SRP was only considered for a limited number of patients as it was a technically challenging procedure and carried the risk of complications such as incontinence. However, studies have demonstrated a reduced major complication rate over time as well as high disease-free survival (DFS). [Urologe A 2006;45:1260-1265; J Urol 2004;172:2239-2243; Eur Urol 2011;60:205-210; J Urol 2009;182:517-525]
“SRP, performed either via open or robotic-assisted laparoscopic approaches, is not a common procedure for men with prostate adenocarcinoma in Singapore,” said Dr. Gerald Tan, Senior Consultant Urologist and Robotic Surgeon at Mount Elizabeth Novena Specialist Centre.
“Nowadays, robotic-assisted radical prostatectomy, with or without PLND, has become the popular first-line treatment of choice for early prostate cancer. PLND is an effective procedure, and it has been found to reduce the risk of biochemical recurrence and disease progression. However, it is associated with short-term side effects such as scrotal or leg swelling (scrotal or limb lymphoedema) or abdominal collections (lymphocele),” said Tan.
“To balance the benefits versus the risks of performing PLND, the European Association of Urology 2015 Guidelines on Prostate Cancer recommends performing PLND for prostate cancer patients who have >7 percent risk of pelvic lymph node involvement, based on predictive normograms using the patient's serum prostate-specific antigen (PSA), prostate biopsy score and digital rectal examination findings,” he said.