SALVAGE RADICAL PROSTATECTOMY IN THE MANAGEMENT OF LOCALLY RECURRENT PROSTATE-CANCER AFTER I-125 IMPLANTATION

Objective To define the role of salvage prostatectomy in patients who have locally recurrent prostate cancer following pelvic lymph node dis section and I-125 implantation. Patients and methods Over 1000 patient s underwent I-125 implantation for localized prostate cancer at the Me morial Sloan Kettering Cancer Center between 1970 and 1986. Salvage ra dical prostatectomy was performed in a highly selected group of 10 pat ients with locally recurrent disease. Results Three of the 10 patients had organ-confined residual prostate cancer following salvage radical prostatectomy. The remaining seven patients had extraprostatic diseas e including four patients with positive surgical margins. Two patients with organ-confined disease and one with extracapsular tumour had no evidence of locally recurrent or metastatic disease and continue to ha ve undetectable prostate-specific antigen (PSA) levels at 50, 44, and 31 months following salvage radical prostatectomy. Alter a mean follow -up of 30 months, the remaining seven patients had a rising PSA level consistent with locally persistent and/or metastatic disease (median 5 ng/mL; range 1.0-144). This PSA elevation occurred within 20 months o f salvage radical prostatectomy (median 6 months). Two of these patien ts developed clinically evident bone metastases. Conclusion Salvage ra dical prostatectomy, although technically feasible in highly selected patients, should not be widely advocated as an effective treatment opt ion for patients with locally recurrent prostate cancer after I-125 im plantation.