Treatment of patients after failed high intensity focused ultrasound and radiotherapy for localized prostate cancer: salvage laparoscopic extraperitoneal radical prostatectomy.

INTRODUCTION

To evaluate the feasibility and efficacy of salvage endoscopic extraperitoneal radical prostatectomy (EERPE) in recurrent prostate cancer after failed high intensity focused ultrasound therapy (HIFU), external beam radiotherapy (EBT) and brachytherapy.

PATIENTS AND METHODS

Twelve patients with mean age 63.3 years (48-74), mean preoperative PSA 12.7 ng/ml and mean prostate weight 48.8 grams were treated with salvage EERPE with curative intent for biopsy proven locally recurrent prostate cancer. Our group was consisted of four patients who have been treated in the past with HIFU, six with EBT and two with brachytherapy. Operative time, estimated blood loss, conversion to open surgery rate, transfusion rate and transurethral catheter time were recorded. Also functional outcome and short term oncological outcome were reviewed.

RESULTS

Average operative time was 153 minutes. Mean blood loss was 238 ml. The procedure was completed in all cases with no difficulty and without intraoperative complications. There was no need for conversion to open surgery or transfusion. Mean total urethral catheterization time was 7.2 days. After mean follow-up of 20 months, 10 patients were completely continent, and 2 needed 1-2 pads per day. Three patients were potent before the surgical treatment, but no one reported potency postoperatively. Biochemical recurrence was observed in only one patient 12 months postoperatively.

DISCUSSION

In the initial experience, salvage EERPE in experienced hands has minimal perioperative morbidity. Short term oncological and functional outcomes are encouraging but further studies and longer follow-up are required in order to assess the long-term outcomes.