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10th ESOU Highlight lecture: radical salvage prostatectomy


25-01-2013      2353 views

The 10th ESOU meeting covered a wide variety of topics to do with the screening, detection, and treatment of urological cancers. One lecture came from ESOU Board Member Prof. Axel Heidenreich, presenting the audience with his experiences of the technique of radical salvage prostatectomy.

On the revived interest in radical salvage prostatectomy, Prof. Heidenreich explained: “This technique has been known for the last 20-30 years. Since then, there have been tremendous improvements in both surgical and radiation technique. The outcome of surgery is not as complicated and poor as it would have been even 15 years ago. These improvements mean that the technique has become much more interesting for current-day urologists.”

“At our centre in Aachen, we’ve performed more than 200 of these procedures in the last five years, it has become quite an established procedure. We can present data on mid-term results, and we can now at least identify which patients might benefit most from this approach. I think there is a lot of potential for these procedures.”

Patients

“If you consider radiation treatment as one of the initial curative treatment options of PCa, we know that, depending on the risk profile, 10-30% of patients will have locally recurrent disease. Looking at the literature, you can see that 90% of those men are just being treated by androgen deprivation treatments, and not by a curative approach.”

Making a case for radical salvage prostatectomy, Prof. Heidenreich points out the advantages. “If you select your patients carefully, you can offer a secondary curative approach. They undergo surgery and have a high chance of remaining cancer-free. This way, they can avoid all the systemic side-effects from other forms of treatment.”

In his experience, Heidenreich has been able to identify which patients could benefit most from a salvage approach. “Specific patients would have been treated with LDR radiotherapy, or patients with organ-defined disease. Prior to radiation treatment, it would be patients with a very slow PSA-doubling time (longer than twelve months) and patients whose prostate biopsy shows less than 50% is involved with cancer.”

Consider it

“With this presentation, I would like to bring this treatment option to the table again, following big improvements in recent years. Urologists should consider secondary local treatment options with curative intent. It is worth thinking about integrating this kind of surgical concept very early in the developmental process of recurrences after radiation treatment.”

In addition to this presentation on the third day of the ESOU meeting, Heidenreich spoke on organ preservation for solid testis neoplasm, and chaired the third session on prostate cancer.



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