Postprostatectomy Salvage Ablation
Compared to salvage ablation therapy following primary radiation, there is considerably less published literature on postprostatectomy ablation and few studies published in the last 2 years. Typical areas of local recurrence can include the bladder neck, vesicourethral anastomosis, and the seminal vesicle beds. Ablation of these areas is typically performed with the guidance of CT or MRI due to the small size of these recurrences as well as the close proximity to important structures including the urethral sphincter, rectum, and ureters.[23,24]
Barat et al. reported on seven patients who under salvage cryotherapy of extraprostatic recurrences (three pelvic lymph nodes, four in prostatectomy bed) following prostatectomy and radiotherapy as part of larger salvage cryotherapy series. All patients were staged with whole-body CT, 18F-fluorocholine PET/CT, and prostate MRI. The procedures were performed under CT guidance. The median follow-up was 20 months. Four patients experienced recurrence at a median of 15 months, three of which had received cryotherapy to the prostate bed. The initiation of ADT was able to be delayed by a median of 15 months. The 2-year disease-free survival was 43%. The authors reported no major complications and the only minor complication reported was transient dysuria in one patient.
One challenge with postprostatectomy ablation is obtaining adequate treatment margin while avoiding injury to surrounding structures, specifically the rectum. A recent series included 13 patients who underwent postprostatectomy MRI-guided cryotherapy of recurrences in the prostate fossa. Saline was infused to displace the rectal wall away from the area of recurrence being ablated. This allowed a median increased margin of 4.6 mm. Oncologic outcomes were not reported.
Curr Opin Urol. 2021;31(3):188-193. © 2021 Wolters Kluwer Health, Inc.