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Salvage radical prostatectomy following focal therapy: functional and oncological outcomes.
Herrera-Caceres, Jaime O; Nason, Gregory J; Salgado-Sanmamed, Noelia; Goldberg, Hanan; Woon, Dixon T S; Chandrasekar, Thenappen; Ajib, Khaled; Tan, Guan Hee; Alhunaidi, Omar; van der Kwast, Theodorus; Finelli, Antonio; Zlotta, Alexandre R; Hamilton, Robert J; Berlin, Alejandro; Perlis, Nathan; Fleshner, Neil E.
Affiliation
  • Herrera-Caceres JO; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Nason GJ; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Salgado-Sanmamed N; Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Goldberg H; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Woon DTS; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Chandrasekar T; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Ajib K; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Tan GH; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Alhunaidi O; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • van der Kwast T; Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Finelli A; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Zlotta AR; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Hamilton RJ; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Berlin A; Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Perlis N; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Fleshner NE; Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada.
BJU Int ; 125(4): 525-530, 2020 04.
Article in En | MEDLINE | ID: mdl-31863617
ABSTRACT

OBJECTIVES:

To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). PATIENTS AND

METHODS:

A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes.

RESULTS:

In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243-19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5-9.5) and 23.5 (15.75-25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5-11) and 6 (5-12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter.

CONCLUSIONS:

sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Prostatectomy / Prostatic Neoplasms Type of study: Observational_studies / Prognostic_studies Limits: Aged / Humans / Male / Middle aged Language: En Journal: BJU Int Journal subject: UROLOGIA Year: 2020 Type: Article Affiliation country: Canada
Fulltext
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Prostatectomy / Prostatic Neoplasms Type of study: Observational_studies / Prognostic_studies Limits: Aged / Humans / Male / Middle aged Language: En Journal: BJU Int Journal subject: UROLOGIA Year: 2020 Type: Article Affiliation country: Canada