Treatment Of Patients After Failed High Intensity Focused Ultrasound And Radiotherapy For Localized Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Radiology / Nuclear Medicine;  Breast Cancer
Article Date: 16 Nov 2008 - 0:00 PDT

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UroToday.com - One of the international leaders in laparoscopic radical prostatectomy, Jens-Uwe Stozenburg from Leipzig, Germany and associates has reported on the use of salvage laparoscopic extra-peritoneal radical prostatectomy (EERPE) following failed high intensity focused ultrasound therapy (HIFU), external beam radiotherapy (ERBT) or brachytherapy.

This report concerns 12 challenging patients who had failed primary therapy: 4 following HIFU, 6 after ERBT and 2 after brachytherapy. The mean age was 63 years, the mean preoperative PSA was 12.7g/ml and all patients underwent metastatic staging prior to salvage EERPE. The mean interval between primary therapy and salvage EERPE was 16 months. All patients underwent non-nerve sparing EERPE and 8 had pelvic lymphadenectomy performed. Two men had prior abdominal surgery and one had open hernia mesh repair and the other open vesiculectomy due to abscess of the seminal vesicle.

The authors noted that the salvage circumstances made the operations "technically more demanding". All prostates were widely excised, and in the brachytherapy patients, seeds were identified in the periprostatic tissue and within the pelvic floor musculature. If a cystogram demonstrated absence of anastomotic leak on day 4 or 5, catheters were removed. Mean EBL was 238ml, and no patients received blood transfusions. Mean operative time was 153 minutes and no patients had conversions to open prostatectomy. No intra-operative or peri-operative complications occurred.

Post-operatively, one patient had urinary retention and was managed with a supra-pubic tube. Pathology showed stage pT2a, pT2b, pT2c, and pT3a in 1, 3, 4, and 4 men, respectively. Positive surgical margins occurred in 50% of the pT3 group and in 12.5% of the pT2 group. One patient experienced a PSA relapse 12 months after salvage EERPE. Regarding continence, 10 men were continent and 2 required 1-2 pads per day.

These data are impressive in such a challenging salvage population. Historical series report up to 60% incontinence rates for post-ERBT open salvage prostatectomy. This small report is certainly better, but may reflect the significant EERPE experience of the authors and likely will be difficult to translate to all surgeons.

Liatsikos E, Bynens B, Rabenalt R, Kallidonis P, Do M, Stolzenburg JU
J Endourol. 2008 Oct;22(10):2295-8
doi:10.1089/end.2008.9713

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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