Prostate Cancer – Local Treatment after Radiorecurrence: Surgery – Back to the future?

Vol. 44 (3): 433-434, May – June, 2018

doi: 10.1590/S1677-5538.IBJU.2018.03.04


DIFFERENCE OF OPINION

Leonardo O. Reis 1,2 Paul L. Nguyen 3
1 Departamento de Oncologia Urológica (UroScience), Pontifícia Universidade Católica de Campinas, PUC – Campinas, SP, Brasil; 2 Universidade Estadual de Campinas, Unicamp, Campinas, SP, Brasil; 3 Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Keywords: Prostatic Neoplasms; Salvage Therapy; Radiation


As radiotherapy advances, inadequate deliveries decrease and salvage radical prostatectomy, when necessary, tends to be less challenging with improving oncological and functional results. It treats cancer foci in regions such as apex or periurethral tissue, often spared in ablative approaches to minimize side effects; adds the clear goal of an undetectable PSA; and the opportunity for pelvic lymph-node dissection to potentially treat loco regional micrometastasis.

Up to 50% of men may develop recurrence after definitive radiation for prostate cancer, and about one-third of these men will have a biopsy-proven local radiorecurrence, which occurs due to either inadequate delivery of the prescribed radiation dose or inherent biologic resistance of prostate cancer clones to radiation. Standard of care for these patients has been classically observation followed by androgen deprivation (ADT), which adds substantial morbidity and doesn’t offer the possibility of cure.

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