PREDICTORS FOR MAXIMAL OUTCOME IN PATIENTS UNDERGOING SALVAGE SURGERYFOR RADIO-RECURRENT PROSTATE-CANCER

Objectives. To determine preradiation and preoperative clinical stagin g and postoperative pathologic factors that can predict disease-free s urvival in patients undergoing salvage surgery for radio-recurrent pro state cancer. Methods. A retrospective review was performed on 40 pati ents who underwent salvage surgery for radio-recurrent prostate cancer . Preradiation and preoperative clinical staging factors, as well as p athologic stage were analyzed as predictors of disease-free survival. Biochemical failure was defined as a persistent serum prostate-specifi c antigen (PSA) elevation greater than 0.4 ng/mL. Results. As a group, salvage surgery provided excellent clinical disease control in 35 of 40 patients (87.5%). Overall, 18 of 38 (47.4%) patients analyzed had n o evidence of biochemical progression. Preradiation clinical stage and pathologically organ-confined disease were statistically significant predictors of disease-free survival (P = 0.03 and P = 0.02, respective ly). Seminal vesicle invasion and positive lymph nodes were the worst pathologic prognostic factors. Preoperative clinical Tie disease appro ached statistical significance in predicting pathologically organ-conf ined disease and disease-free survival (P = 0.08 and P = 0.07, respect ively). Conclusions. Ideal candidates for salvage surgery should have preradiation and preoperative clinically organ-confined disease. All p atients with pathologically organ-confined disease following salvage p rostatectomy were disease free at a mean follow-up of 36.1 months. Sal vage surgery, although technically feasible, should not be widely advo cated as an effective curative treatment in patients with locally adva nced disease at the time of diagnosis. (C) 1998, Elsevier Science Inc. All rights reserved.