Safety and efficacy of radical prostatectomy for men with locally recurrent prostate cancer

The present review evaluated the efficacy, safety and complications of salvage radical prostatectomy in patients with locally recurrent prostate cancer, and sought for the ideal candidates for this procedure.

Prostate cancer (PCa) is the most common type of cancer in men. Treatment options for PCa which is confined to the gland include surgery, hormone therapy and different types of radiation therapy. A significant number of patients treated with radiotherapy for prostate cancer have recurrences (return of the cancer). These patients may benefit from salvage radical prostatectomy or SRP (complete removal of the prostate gland; used for recurrent PCa). The study summarizes several recent medical articles on SRP.

The ideal candidates for this surgery were described as younger patients with initial localized (confined) prostate cancer (tumor size T1 to T2) and a PSA (Prostate Specific Antigen) level of less than 10 ng/ml. Due to radiation-induced scarring, SRP is more difficult than traditional (initial or primary) prostatectomy. Consequently, complications and side effects from surgery are more common. These mainly involve bladder and sexual problems.

This review found that 36% to 81% (reports from different studies) of patients undergoing SRP had good bladder function after surgery. On the other hand, erectile function following SRP was generally poor with less than 30% of men regaining adequate erectile function. However, these side effects appear to improve over time. Cancer-related 10-year survival after SRP was reported as 70% to 83%, and recurrence rate 5 years after surgery ranged from 37% to 55%.

In summary, SRP can offer a possible cure for locally recurrent prostate cancer with long-term proven survival benefit in selected patients. However, it is a difficult procedure, with a high risk for post-operative complications and unwanted side effects which may decrease the quality of life of these patients. Due to these arguments, patients should be carefully selected for this procedure and candidates should be referred to an experienced surgeon.