Management of recurrent prostate cancer after radiotherapy: long-term results from CALGB 9687 (Alliance), a prospective multi-institutional salvage prostatectomy series

• Published in: Prostate cancer and prostatic diseases 2019-05, Vol.22 (2), p.309-316
• Main Authors: Mohler, James L., Halabi, Susan, Ryan, Stephen T., Al-Daghmin, Ali, Sokoloff, Mitchell H., Steinberg, Gary D., Sanford, Ben L., Eastham, James A., Walther, Philip J., Morris, Michael J., Small, Eric J.
• Format: Article
• Language: English
• Subjects: 631/67/1059; 692/699/67/1059; Aged; Biochemistry; Biomedical and Life Sciences; Biomedicine; Biopsy; Blood transfusion; Brachytherapy; Cancer recurrence; Cancer Research; Cancer surgery; Care and treatment; Control; Disease Management; Erectile dysfunction; Follow-Up Studies; Humans; Incontinence; Kaplan-Meier Estimate; Male; Medical research; Medical treatment; Middle Aged; Morbidity; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Prostate cancer; Prostatectomy; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - epidemiology; Prostatic Neoplasms - therapy; Quality of life; Radiation; Radiation therapy; Radiotherapy; Rectum; Recurrence (Disease); Retreatment; Salvage; Salvage Therapy; Survival; Transfusion; Urinary incontinence; Urological surgery
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-018-0106-1

Background To evaluate efficacy and morbidity prospectively in a contemporary multi-institutional salvage radical prostatectomy (SRP) series. Methods Forty-one men were enrolled between 1997 and 2006, who suffered biopsy-proven recurrent prostate cancer (CaP) after receiving ≥ 60c Gy radiation as primary treatment for cT 1–2 N X M 0 disease. Surgical morbidity, quality of life, biochemical progression-free survival (BPFS) and overall survival (OS) were evaluated. Results Twenty-four men had undergone external beam radiotherapy, 11 brachytherapy, and six both. Median time between radiation and SRP was 64 months. Median age at SRP was 64 years. Pathologic staging revealed 44% pT2, 54% pT3, and 3% pT4. Surgical margins were positive in 17 and 88% were pN0. Twenty-two percent required intraoperative blood transfusion. Three rectal and one obturator nerve injuries occurred. Seventeen of 38 evaluable patients (45%) had urinary incontinence ( ≥ 3 pads/day) prior to SRP; 88% reported urinary incontinence at 6 months, 85% at 12 months, 63% at 24 months after SRP. Furthermore, 37% of men reported impotence prior to SRP; 78% reported impotence at 6 months, 82% at 12 months, and 44% at 24 months after SRP. The 2-, 5- and 10-year BPFS rates were 51, 39, and 33% respectively; the 2-, 5- and 10-year OS rates were 100, 89, and 52%, respectively, at median follow-up 91 months. Conclusions Modern surgical techniques continue to be associated with significant peri-operative complication rates. Nevertheless, SRP may benefit carefully selected patients through durable oncologic control