However, this must be weighed against the possible adverse events, which are increased compared to primary surgery because of the risk of fibrosis and poor wound healing due to radiation.In most contemporary series, organ-confined disease, negative surgical margins, and the absence of seminal vesicle and/or LN metastases were favourable prognostic indicators associated with a better DFS of approximately 70-80%, in comparison with 40-60% in patients with locally advanced PCa [Table 6.3.4: Oncological results of selected salvage radical prostatectomy case series, including at least 30 patientsBCR = biochemical recurrence; CSS = cancer-specific survival; FU = follow-up; mo = months; n = number of patients; PSM = positive surgical margin.Compared to primary open RP, SRP is associated with a higher risk of later anastomotic stricture (47 vs. 5.8%), urinary retention (25.3% vs. 3.5%), urinary fistula (4.1% vs. 0.06%), abscess (3.2% vs. 0.7%) and rectal injury (9.2 vs. 0.6%) [Table 6.3.5: Peri-operative morbidity in selected salvage radical prostatectomy case series, including at least 30 patientsIn general, SRP should be considered only for patients with low comorbidity, a life expectancy of at least 10 years, a pre-SRP PSA < 10 ng/mL and biopsy ISUP grade Salvage cryoablation of the prostate (SCAP) has been proposed as an alternative to SRP, as it has a potentially lower risk of morbidity and equal efficacy. PFS: 3.7 vs. 3.6 mo. Normal PSA values differ after RP and RT, but PSA recurrence almost always precedes clinical recurrence [Prostate-specific antigen is expected to be undetectable within 6 weeks after successful RP [Following RT, PSA drops more slowly as compared to RP. Several series have shown a consistent CSS rate of 82-87% at 10 years [Remember that comorbidity is more important than age in predicting life expectancy in men with PCa. = months; n = number of patients; TD = total dose; SBRT = stereotactic body radiotherapy; w = weeks, yr. = years.The combination of RT with LHRH ADT has definitively proven its superiority compared with RT alone followed by deferred ADT on relapse, as shown by phase III RCTs [Table 6.1.9: Selected studies of use and duration of ADT in combination with RT for PCaSignificant benefit for combined treatment (p = 0.002) seems to be mostly caused by patients with ISUP grade 2-52 mo. Posterior reconstruction from rhabdosphincter is described to either Denonvilliers fascia posterior to bladder or to posterior bladder wall itself.Two trials assessing posterior reconstruction in RALRP found no significant improvement in return to continence [Four RCTs including anterior suspension have also shown conflicting results. = months; n = number of patients; PSA = prostate-specific antigen; yr. = year.Table 6.3.7: Peri-operative morbidity, erectile function and urinary incontinence in selected salvage cryoablation of the prostate case series, including at least 50 patientsIn general, SCAP should be considered only for patients with low comorbidity, a life expectancy of at least 10 years, an initial organ-confined PCa cT1c to cT2, initial ISUP grade Although there is no role for salvage EBRT following local recurrence after previous definitive RT, in carefully selected patients with a good PS, primary localised PCa and histologically proven local recurrence (based on Phoenix criteria [Salvage HIFU has more recently emerged as an alternative thermal ablation option for radiation-recurrent PCa. Use one of the following tools:The need for prostate biopsy is based on PSA level and/or suspicious DRE and/or imaging (see Section 5.2.4). = not reported; OS = overall survival; RP = radical prostatectomy.The SPCG-4 study randomised patients to either WW or RP (Table 6.1.3) [Table 6.1.3: Outcome of SPCG-4 at 15-year follow-up CI = confidence interval; n.r. not as pT4, because it does not carry independent prognostic significance for PCa recurrence [Stage pT4 is only assigned when the tumour invades the bladder muscle wall as determined macroscopically [The independent prognostic value of PCa volume in RP specimens has not been established [Surgical margin is an independent risk factor for BCR. In addition, the long-term impact of preventing 'flare-up' is unknown [Chronic exposure to LHRH agonists results in the down-regulation of LHRH-receptors, suppressing LH and FSH secretion and therefore testosterone production. In a review of the use of SCAP for recurrent cancer after RT, the 5-year biochemical DFS estimates ranged from 50-70%. This was complemented with pelvic floor muscle therapy. These synthetic analogues of LHRH, are delivered as depot injections on a 1-, 2-, 3-, 6-monthly, or yearly, basis. 432 patients were randomised to ADT alone or ADT plus EBRT to the prostate. rPFS: 16.5 vs. 8.3 mo.OS: 32.4 vs. 30.2 mo. pT2/pT3 with positive surgical margins and GS 8-10) post-RP (Table 6.2.5.1). Peri-operative education has been shown to improve long-term patient satisfaction following RP [Although many patients who have undergone RP will experience a return to urinary continence [Prophylactic antibiotics should be used; however no high-level evidence is available to recommend specific prophylactic antibiotics prior to RP (See EAU Urological Infections Guidelines). With a median follow-up of 94 months, MFS did not differ significantly when comparing 243 patients who had ART and 267 patients who had SRT at a PSA < 0.5 ng/mL (92% vs. 91%, p = 0.9) or OS (89% vs. 92%, p = 0.9).

Specifically this intervention involved action planning around patients' needs related to lifestyle changes, weight control, toilet habits, sexuality, and psychological problems. These parameters are included in nomograms created to predict pathologic stage and seminal vesicle invasion after RP and RT failure [A prostate biopsy that does not contain glandular tissue should be reported as diagnostically inadequate.