Outcomes of Salvage Radical Prostatectomy for M0 Castration-resistant Recurrent Prostate Cancer: A Reasonable Option in the Era of New Antiandrogen Therapies?

There is little evidence regarding salvage radical prostatectomy (sRP) for M0 castration-resistant prostate cancer (CRPC). We reviewed oncological results and complications for 23 men with radiographically recurrent M0 CRPC undergoing sRP at six institutions. Sixteen and ten men experienced at least one and one major (Clavien >2) complication, respectively. After sRP, nine men became incontinent, including two with severe incontinence. The majority of men had aggressive extraprostatic disease (≥pT3b 56.5%; pN1 30.4%; Gleason ≥8 65.2%). Postoperatively 69.6% reached undetectable prostate-specific antigen (PSA) without androgen deprivation therapy (ADT). Seven men had postoperative PSA persistence and six had CRPC persistence. Among the others, biochemical recurrence (BCR) occurred in 68.7% and CRPC in 58.8% at a median of 11 and 31 mo from sRP, respectively. At median follow-up of 4 yr, 17.4% were disease-free, 34.4% had died from PC, and 4.3% had died from other causes. sRP for M0 CRPC is feasible although the risk of complications is significant. A minority of patients can be cured and a significant proportion experience prolonged BCR- and CRPC-free status, thus delaying the need for systemic treatments. Further studies are needed to clarify the role of sRP for M0 CRPC in the era of new antiandrogen therapies. PATIENT SUMMARY: Salvage radical prostatectomy for radiorecurrent M0 castration-resistant prostate cancer (CRPC) is feasible, although continence outcomes are suboptimal and the risk of complications is significant. Survival is promising: some men can be cured and others experience a period without evidence of PC or CRPC. More research is needed to confirm our findings and demonstrate survival benefits.