Introduction

Salvage radical prostatectomy (sRP) represents a valid treatment option with curative intent, in men with biochemical recurrence (BCR). We evaluated oncological outcomes of a contemporary series of sRP.

Methods

Three hundred seventy-six men with biochemical recurrence (BCR), who underwent sRP between 2000 and 2015 at 13 Tertiary referral centres, were retrospectively analysed. Age, PSA, clinical and pathological TNM, primary and pre-sRP biopsy and sRP gleason score (GS), surgical margins, imaging type and positive sites, lymphadenectomy template used, number of lymph-nodes removed and positive, ASA score and ECOG performance status and use of hormonal treatment (HT) were collected for each patient. Exclusion criteria were a follow up <12 months or unavailability of the data. Continuous variables were tested for normal distribution and then compared using Wilcoxon-Mann-Whitney test; differences in categorical variables were assessed by Chi-square or Fisher's exact tests.

Results

Two hundred forty-three men were included. Primary treatments were external beam radiation therapy in 69.5%, cryotherapy in 3.7%, HIFU in 4.1%, brachytherapy in 21.4% and other primary treatments in 1.2% of the patients. Mean PSA and age pre-sRP were 6.32 ±8.23ng/mL and 64.7 ±8.35 years, respectively. Pre-operatively, 1 men had radiological evidence of retroperitoneal nodal involvement, no extra-nodal metastasis were present, 88 men (37.13%) were on HT whereas 15 (6.22%) had castration resistant prostate cancer (CRPC). ASA score was 3 in 63 (26%) patients. A super-extended lymphadenectomy, including retroperitoneal nodes was performed in 6 cases (2.49%). At final pathology, 85 patients (38.6%) had a GS ≥8, whereas local extra-prostatic extension (T stage≥3) was diagnosed in 118 patients (48.96%). Surgical margins were positive in 89 patients (37.09%). Mean number of nodes removed and positive were 11.6 ±9.27 and 0.68 ±2.55, respectively. After a median follow up of 36.8 months (IQ range 22.7-61.4), BCR had occurred in 104 patients (44.07%) and 16 patients (6.5%) developed CRPC. Overall survival (OS) was 92.95% and cancer specific survival (CSS) 95.85%.

Conclusions

Promising oncological outcomes can be achieved by salvage radical prostatectomy. Although significant rates of BCR and positive surgical margins are observed, OS and CSS prove relatively high on a short-medium term follow-up. To validate the present findings, longer follow-up and higher number of patients are needed.

Funding

None