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.

Fig. 1

Kaplan-Meier curves reflecting proportion of patients free from (a, d) biochemical recurrence, (b) metastasis, and (c) prostate cancer–specific death following salvage radical prostatectomy (SRP). (d) Low-risk subpopulation (n = 93; pre-SRP prostate-specific antigen ≤4 ng/ml and pre-SRP biopsy Gleason score ≤7). Dashed lines indicate 95% confidence intervals.

Fig. 1

Kaplan-Meier curves reflecting proportion of patients free from (a, d) biochemical recurrence, (b) metastasis, and (c) prostate cancer–specific death following salvage radical prostatectomy (SRP). (d) Low-risk subpopulation (n = 93; pre-SRP prostate-specific antigen ≤4 ng/ml and pre-SRP biopsy Gleason score ≤7). Dashed lines indicate 95% confidence intervals.

Fig. 1

Kaplan-Meier curves reflecting proportion of patients free from (a, d) biochemical recurrence, (b) metastasis, and (c) prostate cancer–specific death following salvage radical prostatectomy (SRP). (d) Low-risk subpopulation (n = 93; pre-SRP prostate-specific antigen ≤4 ng/ml and pre-SRP biopsy Gleason score ≤7). Dashed lines indicate 95% confidence intervals.

Fig. 1

Kaplan-Meier curves reflecting proportion of patients free from (a, d) biochemical recurrence, (b) metastasis, and (c) prostate cancer–specific death following salvage radical prostatectomy (SRP). (d) Low-risk subpopulation (n = 93; pre-SRP prostate-specific antigen ≤4 ng/ml and pre-SRP biopsy Gleason score ≤7). Dashed lines indicate 95% confidence intervals.