Salvage Radical Prostatectomy Morbidity Has Declined

NEW YORK (Reuters Health) Dec 15 - Salvage radical prostatectomy offers
patients with recurrent prostate cancer after radiation therapy an
opportunity for long-term cancer control, and the procedure has an
"acceptable morbidity profile," New York- based researchers report in
the December issue of the Journal of Urology.

"Salvage radical prostatectomy is technically demanding, but the
procedure can be performed safely by an experienced surgeon," senior
investigator Dr. James A. Eastham told Reuters Health. "Although rates
of urinary incontinence and erectile dysfunction are higher than after
standard radical prostatectomy, these outcomes continue to improve."

Dr. Eastham of Memorial Sloan-Kettering Cancer Center and colleagues
came to this conclusion after reviewing data from 100 patients who,
between 1984 and 2003, underwent the procedure following external beam
or interstitial radiotherapy.

Between 1993 and 2003, the major complication rate dropped significantly
from 33% to 13% and the rectal injury rate fell from 15% to 2%.

Moreover, compared with retropubic interstitial radiotherapy, with or
without pelvic lymph node dissection, there was a significantly lower
risk of complications following external beam radiotherapy or
transperineal interstitial radiotherapy (odds ratio, 0.2).

At 5 years, an estimated 68% of patients required one pad daily or less
and 39% were not incontinent. Moreover, 23 patients who required three
or more pads daily were continent after artificial sphincter placement.

Overall, the 5-year potency rate was 28% following unilateral or
bilateral nerve-sparing radical prostatectomy. It was 45% in previously
potent patients.

Thus, the researchers conclude that the "acceptable morbidity profile of
salvage radical prostatectomy following external beam radiotherapy and
transperineal radiotherapy should persuade more physicians to consider
patients for this potentially curative procedure."

J Urol 2004;172:2239-2243.