Surgical Approaches In Treating Prostate Cancer: Salvage Therapy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 19 Sep 2008 - 7:00 PDT

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BERLIN, GERMANY (UroToday.com) - Dr. Reza Ghavamian, Albert Einstein College of Medicine, reviewed the therapeutic options available to patients experiencing radiation therapy failure.

These options include watchful waiting, androgen deprivation, salvage radical prostatectomy, salvage cystoprostatectomy, salvage cryotherapy, salvage brachytherapy, and HIFU.

Although the data presented indicated that open radical prostatectomy was associated with a significant risk of incontinence, rates between 27-68%, he felt that salvage urethral sparing therapies such as cryosurgery and HIFU, although better tolerated with lower morbidity, were not appropriate options since in 65% of patients undergoing salvage prostatectomy, viable prostate cancer will be found within 2 mm of the urethra. Salvage cryotherapy utilizes a urethral warmer and salvage HIFU often spares the urethra. In his review of the literature, he felt that the most appropriate candidates for salvage, non-hormonal therapy intervention were those with >2 years between RT and failure, a PSADT >8-12 mos, and a PSA at salvage therapy <10 ng/ml. Dr. Ghavamian defined the ideal candidate as one with no major co-morbidities, a life expectancy of >15 years, no evidence of metastases, unequivocally clinically localized disease on presentation, who is highly motivated and willing to accept a higher morbidity. He presented data that TR-MRI may be very useful, in this setting, in patient selection - though the experience with this in the treatment failure setting remains limited.

Lastly, Dr. Ghavamian felt that for appropriate candidates, salvage RP afforded unsurpassed outcomes.

Presented by Reza Ghavamian, MD, at the Annual Meeting of the American Urological Association - New York Section - September 6 - 13, 2008 - Berlin, Germany

Reported by UroToday.com Contributing Editor Mitchell C. Benson, MD

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