Salvage Therapy for Prostate Cancer

2013 ◽  
Vol 09 (01) ◽  
pp. 21
Author(s):  
Karin E Westesson ◽  
Andrew J Stephenson ◽  
◽  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Salvage Therapy ◽  
Biochemical Recurrence ◽  
Survival Benefit ◽  
Recurrent Disease ◽  
External Beam Radiotherapy ◽  
Appropriate Treatment ◽  
Salvage Brachytherapy ◽  
Salvage Radical Prostatectomy

Biochemical recurrence after treatment of prostate cancer occurs in 30–50 % of patients. Confirming that recurrence is localized to the pelvis is challenging as PSA is nonspecific and imaging modalities are imperfect in identifying location of recurrent disease. Salvage therapy after radical prostatectomy is limited to external beam radiotherapy and androgen-deprivation therapy. After radiotherapy, local salvage therapy consists of salvage radical prostatectomy, salvage brachytherapy, and salvage high-intensity ultrasound. Each treatment modality provides various rates of cure but with its own side-effect profile, prompting discussion between patient and clinician to determine appropriate treatment course. Local salvage therapy has the potential to be curative and disease control has been reported in a substantial number of select patients. However, the survival benefit of these therapies has yet to be definitively proved.

Role of Salvage Radical Prostatectomy for Recurrent Prostate Cancer After Radiation Therapy

2005 ◽  
Vol 23 (32) ◽  
pp. 8198-8203 ◽  
Author(s):  
Andrew J. Stephenson ◽  
James A. Eastham
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Radical Prostatectomy ◽  
Local Recurrence ◽  
Salvage Therapy ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Cancer Control ◽  
Increased Risk ◽  
Salvage Radical Prostatectomy

Patients with isolated local recurrence of prostate cancer after radiation therapy may potentially be cured of their disease by salvage radical prostatectomy (RP). The stage-specific 5-year cancer-control rates of salvage RP resemble those of standard RP. However, the ability to effectively administer salvage treatment to patients with radiorecurrent disease is compromised by the lack of diagnostic tests with sufficient sensitivity and specificity to detect local recurrence at an early stage while it is amenable to local salvage therapy. By the time biochemical recurrence is declared using the current American Society for Therapeutic Radiology and Oncology definition, the majority of patients have advanced local disease, precluding successful local salvage therapy. When salvage RP is performed at prostate-specific antigen levels of 10 ng/mL or less, an estimated 70% of patients are free of disease at 5 years. With better patient selection and technical modifications, the morbidity associated with salvage RP has improved substantially. Rates of urinary incontinence and anastomotic stricture are acceptable, although one third of patients will experience these complications. Salvage cryotherapy is a minimally invasive alternative to salvage RP, but cancer-control rates appear to be inferior and it does not provide a clear advantage over salvage RP in terms of reduced morbidity. Patients with local recurrence after radiation therapy are at increased risk of metastatic progression and cancer-specific mortality. Currently, salvage RP represents the only curative treatment option for these patients. Salvage RP may favorably alter the natural history of biochemical recurrence after radiation therapy, but it must be instituted early in the course of recurrent disease to be effective.

scholarly journals Salvage Radical Prostatectomy after External Beam Radiation Therapy: A Systematic Review of Current Approaches

2015 ◽  
Vol 94 (4) ◽  
pp. 373-382 ◽  
Author(s):  
Deliu Victor Matei ◽  
Matteo Ferro ◽  
Barbara Alicja Jereczek-Fossa ◽  
Giuseppe Renne ◽  
Nicolae Crisan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Salvage Therapy ◽  
External Beam Radiotherapy ◽  
Local Treatment ◽  
Localized Prostate Cancer ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Selection Of

Background: Radical external beam radiotherapy (EBRT) is a standard treatment for prostate cancer patients. Despite this, the rate of intraprostatic relapses after primary EBRT is still not negligible. There is no consensus on the most appropriate management of these patients after EBRT failure. For these patients, local salvage therapy such as radical prostatectomy, cryotherapy, and brachytherapy may be indicated. Objective: The objectives of this review were to analyze the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. Methods: A review of the literature was performed to identify studies of local salvage therapy for patients who had failed primary EBRT for localized prostate cancer. Results: Most studies demonstrated that local salvage therapy after EBRT may provide long-term local control in appropriately selected patients, although toxicity is often significant. Conclusions: Our results suggest that for localized prostate cancer recurrence after EBRT, the selection of a local treatment modality should be made on a patient-by-patient basis. An improvement in selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological outcome and least comorbidity.

scholarly journals Salvage Brachytherapy for Castration-Resistant and External Beam Radiotherapy-Resistant Local Recurrence 17 Years after Radical Prostatectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Shogo Hosogoe ◽  
Osamu Soma ◽  
Teppei Matsumoto ◽  
Atsushi Imai ◽  
Shingo Hatakeyama ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Local Recurrence ◽  
Ct Scan ◽  
External Beam Radiotherapy ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Old Japanese ◽  
Salvage Brachytherapy

A 47-year-old Japanese man was diagnosed with prostate cancer in February 1995 (Initial PSA 77.2 ng/mL, GS3 + 4, cT3N0M0). He underwent radical prostatectomy after androgen deprivation therapy (ADT) in June 1995. Nine years after operation, he was diagnosed with local recurrence of prostate cancer and he received postoperative external beam radiation therapy (EBRT) (70 Gy). By May 2008, the PSA dropped to 0.33 ng/mL, and a CT scan showed that the mass had disappeared. On April 2012, the PSA once again rose to 3.1 ng/mL. CT scan and MRI revealed a mass in the prostatic bed. We diagnosed local recurrence of prostate cancer. We underwent salvage low-dose brachytherapy after obtaining informed consent. The prescribed dose of the salvage brachytherapy was 145 Gy to control the tumor considering the hormone resistant prostatic cancer and high-risk feature. PSA level rapidly decreased to 0.66 ng/mL by 6 months after seed implantation. No adverse events were seen during the follow-up period.

scholarly journals Metastasis After Radical Prostatectomy or External Beam Radiotherapy for Patients With Clinically Localized Prostate Cancer: A Comparison of Clinical Cohorts Adjusted for Case Mix

2010 ◽  
Vol 28 (9) ◽  
pp. 1508-1513 ◽  
Author(s):  
Michael J. Zelefsky ◽  
James A. Eastham ◽  
Angel M. Cronin ◽  
Zvi Fuks ◽  
Zhigang Zhang ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Salvage Therapy ◽  
External Beam Radiotherapy ◽  
Hazard Ratio ◽  
Biochemical Failure ◽  
Localized Prostate Cancer ◽  
Case Mix ◽  
External Beam ◽  
Metastatic Progression

Purpose We assessed the effect of radical prostatectomy (RP) and external beam radiotherapy (EBRT) on distant metastases (DM) rates in patients with localized prostate cancer treated with RP or EBRT at a single specialized cancer center. Patients and Methods Patients with clinical stages T1c-T3b prostate cancer were treated with intensity-modulated EBRT (≥ 81 Gy) or RP. Both cohorts included patients treated with salvage radiotherapy or androgen-deprivation therapy for biochemical failure. Salvage therapy for patients with RP was delivered a median of 13 months after biochemical failure compared with 69 months for EBRT patients. DM was compared controlling for patient age, clinical stage, serum prostate-specific antigen level, biopsy Gleason score, and year of treatment. Results The 8-year probability of freedom from metastatic progression was 97% for RP patients and 93% for EBRT patients. After adjustment for case mix, surgery was associated with a reduced risk of metastasis (hazard ratio, 0.35; 95% CI, 0.19 to 0.65; P < .001). Results were similar for prostate cancer–specific mortality (hazard ratio, 0.32; 95% CI, 0.13 to 0.80; P = .015). Rates of metastatic progression were similar for favorable-risk disease (1.9% difference in 8-year metastasis-free survival), somewhat reduced for intermediate-risk disease (3.3%), and more substantially reduced in unfavorable-risk disease (7.8% in 8-year metastatic progression). Conclusion Metastatic progression is infrequent in men with low-risk prostate cancer treated with either RP or EBRT. RP patients with higher-risk disease treated had a lower risk of metastatic progression and prostate cancer–specific death than EBRT patients. These results may be confounded by differences in the use and timing of salvage therapy.

232: Natural History of Treated Biochemical Recurrence after Radical Prostatectomy for Prostate Cancer

2007 ◽  
Vol 177 (4S) ◽  
pp. 77-78
Author(s):  
Christopher R. Porter ◽  
Jochen Walz ◽  
Andrea Gallina ◽  
Claudio Jeldres ◽  
Koichi Kodama ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Natural History ◽  
Biochemical Recurrence ◽  
History Of
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