Open salvage radical prostatectomy for recurrence of prostate cancer after radiation therapy
© Springer Science+Business Media New York 2014.There are a number of treatment options for men with local recurrence of prostate cancer after radiation therapy (RT). While technically challenging, salvage radical prostatectomy (RP) provides excellent local control and can eradicate the disease in a high proportion of patients whose cancer is confined to the prostate or immediate periprostatic tissue. Patient considering salvage RP should be in excellent health with a life expectancy of at least 10 years. Patients should have no evidence of distant metastatic disease and no evidence of lymph node involvement before or after RT. The cancer (whether initial or recurrent) should be clinically organ-confined and potentially curable. Serum prostate-specific antigen (PSA) level and biopsy Gleason score before salvage RP are significantly associated with death from prostate cancer. As with standard RP, patient selection is of utmost importance in planning appropriate treatment. Salvage RP is technically feasible using current surgical techniques with satisfactory immediate intraoperative and postoperative outcomes. The majority of patients can be treated via a retropubic approach. Short-term and long-term complications are more common after salvage RP than standard RP, partly because the normal anatomic planes are lost as a consequence of RT. The most significant late complications include development of an anastomotic stricture and/or persistent urinary incontinence. This chapter highlights the technique of open salvage RP emphasizing an anatomical approach that has been adapted over time to maximize safe removal of the entire cancer while minimizing the potential for intraoperative and postoperative complications.
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