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Organo Oficial de la Sociedad Mexicana de Urología

2011, Number 2

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Rev Mex Urol 2011; 71 (2)

Evaluation and treatment options for patients with failure after prostatectomy for localized prostate cancer

Zonana-Farca E, Sedano-Lozano A, Ramírez-Pérez EA

Language: Spanish
References: 85
Page: 111-127
PDF size: 327.18 Kb.


ABSTRACT

Radical prostatectomy is the standard treatment for patients with clinically localized prostate cancer. There are positive surgical margins or extraprostatic tumoral extension in the surgical specimens of approximately one third of patients. Many of these patients can present with biochemical failure and local disease recurrence. Preoperative prostate specific antigen value, number of positive biopsies, surgical specimen Gleason score, positive margins, extraprostatic extension, and seminal vesicle invasion have been shown to be significant risk factors. Positive margins with no evidence of extraprostatic extension do not necessarily constitute a risk factor, given that this alteration may be conditioned by the surgeon.
Few imaging studies provide a high level of accuracy for early detection of local disease recurrence. C-11 acetate positron emission tomography is possibly the most promising of them.
Treatment of patients with biochemical failure remains controversial. For patients presenting with positive surgical margins and/or established extraprostatic extension, the urologist will often decide on watchful waiting until prostate specific antigen reaches a certain value (1.5 ng /mL or higher) and then initiate hormonal treatment or indicate salvage radiotherapy, neither of which has shown important benefits for the patient.
Randomized studies have demonstrated the usefulness of adjuvant radiotherapy and/or hormonal treatment following radical prostatectomy in patients with pathological signs of extraprostatic extension, resulting in improvement in biochemical failure-free survival and overall survival. In the present author’s opinion, combined adjuvant therapy consisting of radiotherapy plus hormonal therapy is a valid option, especially in surgical patients presenting with high risk of local disease recurrence.


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