Prostatectomy complications increased with prior radiotherapy
MedWire News: The likelihood of medical and surgical complications after radical prostatectomy (RP) for prostate cancer is higher if patients have previously undergone radiotherapy for the disease, say US researchers.
Compared with RP as de novo therapy, salvage RP was associated with a higher probability of urinary tract infection, bladder neck contracture, urinary retention, urinary fistula, abscess, and rectal injury.
“Understanding the magnitude of this increased risk is essential for patient counseling at initial diagnosis in the event of the need for salvage therapy,” suggest Farhang Rabbani, from the Montefiore Medical Center in New York, USA, and colleagues.
The team evaluated medical and surgical complication rates in a cohort of 3458 men who underwent de novo RP, and 98 men who underwent salvage RP after previous external beam radiotherapy (n=64), brachytherapy (n=21), or combination therapy including radiation (n=13).
Although there were no significant differences in estimated blood loss, operative time, or length of hospital stay, salvage RP patients were less likely than de novo patients to have organ-confined disease (44% vs 69%), more likely to have positive lymph nodes (16% vs 5%), and more likely to have seminal vesicle invasion (32% vs 8%).
Salvage RP patients also experienced more medical (26% vs 9%) and surgical (53% vs19%) complications than de novo RP patients.
After adjusting for factors including clinical stage, biopsy Gleason score, organ confined status, and body mass index, average rates of urinary tract infections and bladder neck contractures were higher among salvage RP patients than de novo patients, at 20.4% versus 2.8%, and 47.0% versus 5.8%, respectively.
There was also a significant association between rectal injury and subsequent fistula in salvage RP patients, of whom 22% experienced this complication compared with none of the de novo RP-treated group.
With regards to erectile function and urinary continence, Rabbani et al report that only one of four men who were potent before salvage RP recovered adequate function for intercourse, and continence recovery occurred in only 30% of salvage RP patients after 3 years.
The team writes in the Journal of Urology that the alternatives to salvage RP – salvage cryotherapy and high intensity focused ultrasound – offer potentially more favorable complication profiles.
However, they add that “efficacy rates appear to be lower than the 47% to 65% 5-year disease-free rate reported for salvage RP.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By Sarah Guy