Salvage Therapy for Prostate Cancer

Preface
Acknowledgements
Contents
About the Authors
Abbreviations
1: Systematic Review of Open, Laparoscopic and Robotic Salvage Radical Prostatectomy
1.1 Introduction
1.2 Systematic Review Methods
1.3 Results
1.3.1 Open Salvage Prostatectomy Results
1.3.2 Laparoscopic Salvage Prostatectomy Results
1.3.3 Robotic Salvage Prostatectomy Results
1.4 Comparison of Outcomes
1.5 Discussion
1.6 Concluding Remarks
References
2: Salvage Prostatectomy for Radio-Recurrent Prostate Cancer
2.1 Introduction
2.2 Histopathological and Morphological Radiation-Induced Modifications of Pelvic Tissues
2.3 Radio-Recurrent Prostate Cancer Patients’ Selection
2.4 Pre-SRP Staging
2.5 Salvage Radical Prostatectomy: Surgical Technique
2.5.1 Endopelvic Fascia Incision
2.5.2 Posterior Plane Dissection
2.5.3 Prostate Apex Dissection
2.5.4 Neurovascular Bundle Dissection
2.5.5 Role of Experienced Surgeons
2.6 Oncological Outcomes
2.7 Functional Results
2.7.1 Surgical Complications
2.7.2 Blood Loss
2.7.3 Rectal Injury
2.7.4 Anastomotic Leakages
2.7.5 Urethral Strictures
2.7.6 Continence and Erectile Function Preservation
2.8 Future Directions
2.9 Conclusions
References
3: Salvage Robot-Assisted Radical Prostatectomy for Recurrent Localized Prostate Cancer after Radiation Therapy
3.1 Current Position of Salvage Radical Prostatectomy
3.2 Indication and Preoperative Assessment
3.2.1 Indication
3.2.2 Preoperative Assessment
3.3 Surgical Technique: Contribution of Robotics
3.3.1 Patient Positioning and Surgical Approach
3.3.2 Lymph Node Dissection / Risk of Oedema
3.3.3 Endopelvic Fascia Dissection
3.3.4 Posterior Dissection of the Prostate
3.3.5 Apical Dissection
3.3.6 Vesicourethral Anastomosis
3.4 Results
3.4.1 Perioperative Outcomes—Intraoperative Data
3.4.1.1 Blood Loss and Operative Time
3.4.1.2 Rectal Injury
3.4.1.3 Recto-bladder Fistula
3.4.2 Perioperative Outcomes–Postoperative Data
3.4.2.1 Anastomotic Leakage
3.4.2.2 Anastomotic Stricture
3.4.2.3 Postoperative Complications
3.5 Oncological Outcomes
3.6 Functional Outcomes
3.6.1 Postoperative Continence
3.6.2 Postoperative Erectile Dysfunction
3.7 Conclusion
References
4: Disease Recurrence after Radical Prostatectomy
4.1 Rising Prostate-Specific Antigen (PSA) after Prostatectomy
4.2 Persistent PSA after Prostatectomy
4.3 Incidence of Recurrence
4.4 Risk Stratification in Patients with Post-Prostatectomy Recurrence or PSA Persistence
4.4.1 Post-Prostatectomy Recurrence
4.4.2 Persistently Elevated PSA after Prostatectomy
References
5: Salvage Therapy in Prostate Cancer: Predictors of Recurrence
5.1 Research Methods
5.2 Systematic Review Results
5.2.1 Predictors of Response Post Salvage Whole Gland HIFU
5.3 Predictors of Recurrence after Salvage Radiotherapy for Prostate Cancer
5.4 Predictors of Recurrence after Salvage Brachytherapy
5.5 The Role of Imaging in Predicting Recurrence in Salvage Therapy for Prostate Cancer
5.6 Predictors of Recurrence for Salvage Radical Prostatectomy
5.7 Predictors of Recurrence for Salvage Cryosurgery
5.8 Predictors of Recurrence in Salvage Hormone Therapy
5.9 Systematic Reviews Related to Search Terms
5.10 Conclusion
References
6: The Role of MRI in Recurrent Prostate Cancer
6.1 Introduction
6.2 Multiparametric MRI after Radical Prostatectomy
6.3 Multiparametric MRI after Radiotherapy
6.4 Multiparametric MRI after External Beam Radiotherapy
6.5 Multi-parametric MRI after Brachytherapy
6.6 Multiparametric MRI after Focal Therapy
References
7: Clinical Staging/Diagnostic Imaging in Salvage Therapy for Prostate Cancer
7.1 Rising PSA—PSA Recurrence
7.1.1 Assessment of Local Recurrences
7.2 Persistent PSA Post Radical Prostatectomy
7.2.1 Imaging in Patients with Persistently Elevated PSA after Radical Prostatectomy
7.2.2 Choline PET-CT
7.2.3 Fluciclovine PET-CT
7.2.4 PSMA Pet-CT
References
8: Imaging for Salvage Therapy in Recurrent Prostate Cancer
8.1 Introduction
8.2 Prostate-Specific Membrane Antigen (PSMA) Imaging
8.3 Performance and Impact of PSMA Imaging in Recurrent PCa
8.4 Where is the Place of PSMA Imaging before Salvage Lymphadenectomy
8.5 Conclusion
References
9: The Role of PET in Salvage Therapy for Prostate Cancer
9.1 Research Methods
9.2 Systematic Review Results
9.2.1 PSMA PET Versus Choline PET for Salvage Lymph Node Dissection
9.2.2 The Role of PET Post Radical Prostatectomy
9.2.3 The Role of Fluciclone PET in Detection of Prostate Cancer Recurrence
9.2.4 PSMA-PET Guided Salvage Radiotherapy
9.2.5 Choline PET Guided Radiotherapy
9.2.6 The Role of PET in Salvage Lymph Node Dissection
9.2.7 The Role of Choline PET After Radical Radiotherapy for Prostate Cancer
9.2.8 The Role of PET Post Salvage Radiotherapy in Prostate Cancer
9.2.9 The Role of PET in Salvage Radiotherapy for Oligometastatic Disease
9.2.10 The Role of PET in Salvage Lymph Node Dissection
9.2.11 The Role of PSMA-PET in Biochemical Failure in Prostate Cancer
9.2.12 MRI Versus PSMA PET in Detection of Prostate Cancer Recurrence
9.2.13 PSMA PET Versus Choline PET in Detection of Prostate Cancer Recurrence
9.2.14 The Role of Choline PET in Detection of Prostate Cancer Recurrence
9.2.15 The Role of 18 FDG PET in Prostate Cancer Recurrence
9.2.16 PSMA PET Versus Choline PET Versus Standard CT in Prostate Cancer Recurrence
9.2.17 MRI Versus Choline PET in Biochemical Recurrence of Prostate Cancer
9.2.18 Choline PET Versus ACE PET in the Restaging of Recurrence Prostate Cancer
9.2.19 GRPr-PET in Biochemical Recurrence of Prostate Cancer
9.2.20 ACE PET in Detection of Recurrent Prostate Cancer
9.2.21 Choline PET Versus ACE PET for Recurrent Prostate Cancer
9.2.22 SPECT CT Versus PSMA PET in Recurrence of Prostate Cancer
9.3 Conclusions
References
10: Salvage Radiotherapy
10.1 Impact of Post-operative RT in Patients with Persistent PSA
10.2 Radiotherapy Techniques and Protocols in the Post-prostatectomy Patient
10.3 Androgen Deprivation Therapy
10.4 Treatment Outcomes
10.4.1 Oncological Outcomes
10.4.2 Toxicity
10.4.3 Quality of Life (QoL)
10.4.4 Salvage Radical Prostatectomy
References
11: Salvage Cryotherapy in Prostate Cancer
11.1 Research Methods
11.2 Systematic Review Results: Difficulties in Prostate Cancer Diagnostics with Salvage Cryotherapy
11.3 Post Salvage Cryotherapy Histological Findings
11.4 Outcomes from Salvage Cryotherapy in Prostate Cancer after External Beam Radiotherapy and Brachytherapy
11.5 Salvage Cryotherapy after Primary Radiotherapy for Prostate Cancer
11.6 Side Effects from Salvage Cryotherapy
11.7 Salvage Cryotherapy after Primary Cryotherapy
11.8 Outcomes and Toxicity between Salvage Prostatectomy and Salvage Cryotherapy
11.9 Predictive Factors for Recurrence in Salvage Cryotherapy
11.10 Clinical Factors Associated with Suboptimal Salvage Cryotherapy
11.11 Patient Reported Outcome Measures in Prostate Cancer
References
12: Salvage Treatment after Focal Therapy for Recurrent Prostate Cancer
12.1 Introduction
12.2 Selection of Patients for Focal Therapy
12.3 Definition and How Focal Therapy is Performed
12.4 Prostate-Specific Antigen, mpMRI and Prostatic Biopsies for Follow-up After Focal Therapy
12.5 Definitions of Recurrence After Focal Therapy
12.6 Redo Focal Therapy—To Use the Same or Different Energy
12.7 Radiotherapy
12.8 Radical Prostatectomy
12.9 How Could the Recurrence Rate of Focal Therapy be Improved?
12.10 Addressing Prostatic Microenvironment
12.11 Conclusions
References
13: Salvage Re-Irradiation After Locoregional Failure with Primary Radiotherapy for Prostate Cancer
13.1 Systematic Review Results: High-Dose-Rate Brachytherapy or Focal Stereotactic Body Radiotherapy for Local Recurrence after Primary Radiotherapy
13.2 Cyberknife Radioablation as Re-irradiation Post-Radiotherapy Failure in Prostate Cancer
13.3 External Beam Radiotherapy After Prostate Cancer Recurrence Post-Radiotherapy
13.4 Radiotherapy to the Prostate Bed—the Salvage Scenario
13.5 Ablative re-EBRT using Stereotactic Image-Guided Technique for Isolated Local Recurrence of Prostate Cancer
13.6 Side Effects of Salvage Re-irradiation Post-Primary Radiotherapy for Prostate Cancer
13.7 High Dose Rate Stereotactic Body Radiation Therapy in Prostate Cancer Recurrence Post Radiotherapy
13.8 External Beam Radiotherapy With or Without Brachytherapy Boost Post-Primary Radiotherapy Failure for Prostate Cancer
13.9 Conclusions
References
14: Salvage Brachytherapy—Outcomes from Low- and High-Dose Brachytherapy in Prostate Cancer
14.1 Research Methods
14.2 Systematic Review Results: Outcomes from Low- and High-Dose-Rate Brachytherapy
14.3 Side Effects from Low- and High-dose Salvage Brachytherapy
14.4 Salvage Brachytherapy and ADT
14.5 Focal Partial Salvage Re-implantation after Permanent Brachytherapy
14.6 High-Dose Brachytherapy Outcomes after Radiotherapy
14.7 PSA Bounce Post High-Dose-Rate Brachytherapy
14.8 Conclusions
References
15: Salvage Brachytherapy after Primary Brachytherapy in Recurrent Prostate Cancer
15.1 Research Methods
15.2 Systematic Review Results
15.2.1 Outcomes from Salvage Brachytherapy for Prostate Cancer after Primary Brachytherapy
15.2.2 Side Effects of Salvage Brachytherapy after Primary Brachytherapy
15.2.3 Radiation Dose During Salvage Brachytherapy after Primary Brachytherapy
15.3 Conclusions
References
16: Focal Salvage Therapy for Prostate Cancer Recurrence After Primary Radiotherapy
16.1 Introduction
16.2 Assessment of Recurrence
16.2.1 Assessing of the Distant Metastases
16.2.2 Assessing of the Intra-Prostatic Recurrence
16.2.2.1 Biopsy
16.3 Current Focal Salvage Treatment
16.4 Focal Salvage HIFU
16.5 Focal Salvage Cryoablation
16.6 Focal Salvage Stereotactic Body Radiotherapy (SBRT)
16.7 Focal Salvage High-Dose-Rate Brachytherapy
16.8 Focal Salvage Low-Dose-Rate Brachytherapy (LDRBT)
16.9 Focal Salvage Irreversible Electroporation (IRE)
16.10 Salvage Vesiculectomy
16.11 Conclusions
References
17: Salvage Lymph Node Dissection
17.1 Introduction
17.2 Patient Identification
17.3 Imaging for Nodal Recurrence
17.4 Surgical Aspects of Salvage Lymph Node Dissection
17.5 Oncologic Results
17.6 Key Points
References
18: Salvage Re-irradiation Therapy After Loco-regional Failure for Radiotherapy
18.1 Introduction
18.2 Detection of the Site of Recurrence
18.3 Available Treatment Options for Recurrent PCa After Primary RT
18.4 Salvage Radiation Treatment Options
18.5 External Beam Radiation Therapy
18.6 Brachytherapy
18.7 Low Dose Rate Brachytherapy
18.8 High Dose Rate Brachytherapy
18.9 Stereotactic Body Re-irradiation
18.10 Conclusions
References
19: Role of Metastasectomy in Prostate Cancer Patients Following Primary Treatment
19.1 Introduction
19.2 Metastasectomy in Patients with Recurrence Confined to Non-regional Lymph Nodes
19.3 Metastasectomy for Skeletal (M1b) or Visceral (M1c) Disease
19.4 Skeletal (M1b Disease)
19.5 Lung (M1c Disease)
19.6 Liver (M1c Disease)
19.7 Testis and Penis (M1c Disease)
19.8 Ongoing Trials
19.9 Conclusion
References
20: Incontinence of Urine after the Treatment of Prostate Cancer
20.1 Introduction
20.2 Anatomy and Physiology
20.3 The Effects of Treatment for Prostate Cancer on Outcome in Terms of Urinary Incontinence
20.4 Bladder Overactivity
20.5 Bladder Neck Obstruction with Chronic Retention and Overflow
20.6 Stress Urinary Incontinence
20.7 The Incidence of Urinary Incontinence
20.8 Investigation of the Patient
20.8.1 History
20.8.2 Causes of Incontinence in a Male after Prostate Cancer Treatment
20.8.3 Investigations
20.8.4 Treatment
20.9 Pelvic Floor Therapy and Management
20.9.1 Prologue
20.9.2 The Role of the Specialist Pelvic Health Physiotherapy in the Management of Urinary Leakage Following Prostate Cancer Treatment
20.9.3 Pelvic Health Physiotherapy
20.9.4 Pre-Operative Pelvic Health Physiotherapy
20.9.5 Pelvic Floor Function and Muscle Fibre Specificity
20.9.6 Pelvic Floor Exercises
20.9.7 How to Assess the Pelvic Floor Muscle Complex and Teach a Specific Pelvic Floor Contraction
20.9.8 How Often Should the Pelvic Floor Exercises Be Done and in What Position
20.10 An Introduction to the Principles of Pelvic Floor Exercises
20.10.1 Long Holds
20.10.2 Short Holds
20.10.3 The Knack
20.10.4 Exercise Frequency
20.10.5 Exercise Compliance
20.10.6 Post-Operative Pelvic Health Physiotherapy
20.10.7 Frequency/Volume Chart (FVC)
20.10.8 Subjective Examination
20.10.9 Conclusions
20.11 Medical Therapy
20.12 Surgical Intervention
20.12.1 Bulking Agents
20.12.2 The Male Sling
20.12.3 The Artificial Urinary Sphincter
20.12.4 Non-surgical Solutions
20.12.5 Conclusion
References
21: Erectile Dysfunction in Salvage Prostate Cancer Therapies
21.1 Salvage Treatments for Radio-Recurrent Prostate Cancer
21.1.1 Salvage Radical Prostatectomy
21.1.2 Cryotherapy
21.1.3 High-Intensity Focussed Ultrasound (HIFU)
21.1.4 Brachytherapy
21.2 Salvage Treatments for Recurrent Prostate Cancer Post Radical Prostatectomy
21.2.1 External Beam Radiotherapy (EBRT)
21.2.2 Androgen Deprivation Therapy (ADT)
21.3 Treatments for Erectile Dysfunction
21.3.1 Structural Changes Post Prostatectomy
21.3.2 PDE5 Inhibitors
21.3.3 Intracavernosal Injections (ICI)
21.3.4 Vacuum Constrictive Devices (VCD)
21.3.5 Failure to Respond to Therapy: Penile Implant Surgery
21.3.5.1 Psychosexual Counselling
21.4 Summary
References
Index