Salvage radical prostatectomy affords promising oncological control

Men with recurrent prostate cancer achieve good oncological control with salvage radical prostatectomy (sRP) in the medium term even with aggressive pathological features, according to a study.

The analysis involved 414 patients who underwent sRP for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centres in the United States, Australia, and Europe. The surgery was performed following radiotherapy in more than half (63.5 percent) of the population.

Prior to sRP, most patients had biopsy Gleason score (GS) ≤7 (55.5 percent) and negative imaging results or prostatic bed involvement only (93.3 percent). Final pathology indicated aggressive histology in 39.7 percent of patients (GS ≥9, 27.6 percent), with 52.9 percent having ≥pT3 disease and 16 percent having pN+. A total of 29.7 percent patients had positive surgical margin.

At the 5-year follow-up, biochemical recurrence (BCR)-free survival was 56.7 percent, cancer-specific survival was 97.7 percent, and overall survival was 92.1 percent.

On multivariable logistic regression analysis, positive margins were significantly associated with pathological T (pT3a: odds ratio [OR], 2.939, 95 percent confidence interval [CI], 1.469–5.879; ≥pT3b: OR, 2.428, 95 percent CI, 1.333–4.423) and N stage (pN1: OR, 2.871, 95 percent CI, 1.503–5.897).

Meanwhile, independent predictors of BCR included pathological T stage (≥T3b: OR, 2.348, 95 percent CI, 1.338–4.117) and GS (>8: OR, 7.183, 95 percent CI, 1.906–27.068).

The study was limited by its retrospective nature and limited follow-up. More studies are warranted to validate the findings.