In patients with biochemical recurrence after radiation, biopsy-proven localized disease, and no evidence of metastases, salvage prostatectomy may potentially improve survival and delay initiation of androgen deprivation therapy. This National Cancer Institute-sponsored multi-institutional study, CALGB 9687 (Alliance), prospectively evaluated the efficacy and morbidity of salvage prostatectomy in 41 men between 1997 and 2006 (Prostate Cancer Prostatic Dis. 2019 May; 22(2):309-316). At a median follow-up 91 months, these investigators observed robust 2-, 5- and 10-year progression-free survival rates of 51%, 39%, and 33% respectively; and 2-, 5- and 10-year overall survival rates of 100%, 89%, and 52%, respectively.
Nevertheless, peri- and post-operative morbidity was high, even within this group of high-volume centers. Twenty-two percent of patients required intraoperative blood transfusion, and 3 rectal and 1 obturator nerve injuries occurred. Prior to surgery, 45% of patients reported urinary incontinence, defined as ≥ 3 pads/day; after surgery, 88%, 85%, and 63% reported urinary incontinence at 6, 12, and 24 months after surgery, respectively. Similarly, 37% reported erectile dysfunction (ED) prior to surgery; 78%, 82% and 44% reported it 6, 12, and 24 months after surgery.
The take-home message is that, while salvage prostatectomy is associated with robust oncologic control, modern surgical techniques remain associated with substantial complications. Future studies should focus on comparative oncologic and quality-of-life analyses between salvage prostatectomy and minimally-invasive, lower-morbidity procedures including salvage cryoablation and salvage high-intensity focused ultrasound (HIFU).
Written by: J. Kellogg Parsons, MD, MHS, Urologist, Professor of Urology, UC San Diego Health, San Diego, California
Read the Full-Text Article: Management of Recurrent Prostate Cancer After Radiotherapy: Longterm Results from CALGB 9687 (Alliance), a Prospective Multiinstitutional Salvage Prostatectomy Series - Full-Text Article