Salvage prostate surgery and factors affecting patient outcome

The authors aimed to determine patient outcome after salvage prostate surgery using patient information.

Prostate surgery is a common cancer treatment that involves surgically removing the prostate gland. Salvage prostate surgery is carried out after radiation therapy (involves directing a beam of radiation at the cancer site to kill cancer cells with minimal damage to normal cells) has failed.

Perioperative factors includes patient information (age, race, previous treatment, year of diagnosis etc) before surgery, during surgery and after surgery that may effect patient outcome and can be used in prostate cancer to determine the success of salvage prostate surgery.

The aim of this study was to determine patient outcome following salvage prostate surgery using patient information. 408 patients were evaluated.

58.6% of patients who underwent surgery were under 65 years of age. 64% had tumors that could not be felt or seen by a doctor and had an average prostate specific antigen (PSA – protein elevated in the blood when prostate cancer is present) level between 12-16ng/ml.

The most common form of radiation received before surgery was external beam radiation therapy (source of radiation is pointed at a particular part of the body from the outside) (89%) followed by brachytherapy (source of radiation is placed inside of the body at the tumor site) (11%). The odds of experiencing positive surgical margins (tissue surrounding the tumor removed during surgery still shows signs of cancer) after surgery were nearly 4 times higher in patients with a PSA level of more than 20.

Following surgery, 73% of patients had intermediate or high-grade cancer (cancer has grown through the prostate or has spread out of the prostate) where 43% had a Gleason score (rating system from 1-10 that compares the differences between cancerous and normal cells) of 7 and 30% had a Gleason score of 8-10.

Following surgery patients on average remained in recovery for 3-10 days. Only 6.5% were admitted again following surgery and mortality rates following surgery were extremely low at 0.4%. The odds of staying in recovery after surgery were over 4 times higher in patients with a PSA of more than 20ng/ml before surgery and 2.5 times higher in patients with more advanced tumors before surgery.

The authors conclude that a PSA level of more than 20ng/ml between radiation therapy and prostate surgery was independently associated with positive surgical margins and led to more time in recovery.

This is the first article of its kind and requires further validation to be widely applied.

If you are considering prostate surgery please consult your doctor for potential risks and benefits.