Giancarlo Marra1, Paolo Gontero1, Jochen Christoph Walz2, Arjun Sivaraman3, Rafael Tourinho-Barbosa4, Xavier Cathelineau4, Rafael Sanchez-Salas5. 1. Department of Urology, San Giovanni Battista Hospital, Città Della Salute e della Scienza and University of Turin, Turin, Italy. 2. Department of Urology, Institut Paoli-Calmettes, Marseille, France. 3. Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA. 4. Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. 5. Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. raersas@gmail.com.
Abstract
BACKGROUND: Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown. OBJECTIVES: To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT. MATERIALS AND METHODS: A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an 'a priori protocol'. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT. RESULTS: Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7-62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6-38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed. CONCLUSIONS: Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.
BACKGROUND: Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown. OBJECTIVES: To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT. MATERIALS AND METHODS: A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an 'a priori protocol'. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT. RESULTS: Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7-62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6-38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed. CONCLUSIONS: Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.
Authors: Giancarlo Marra; Taimur T Shah; Daniele D'Agate; Alessandro Marquis; Giorgio Calleris; Luca Lunelli; Claudia Filippini; Marco Oderda; Marco Gatti; Massimo Valerio; Rafael Sanchez-Salas; Alberto Bossi; Juan Gomez-Rivas; Francesca Conte; Desiree Deandreis; Olivier Cussenot; Umberto Ricardi; Paolo Gontero Journal: Front Surg Date: 2022-06-07
Authors: Elliot Anderson; Lloyd M L Smyth; Richard O'Sullivan; Andrew Ryan; Nathan Lawrentschuk; Jeremy Grummet; Andrew W See Journal: Transl Androl Urol Date: 2021-09
Authors: Jost von Hardenberg; Hannes Cash; Daniel Koch; Angelika Borkowetz; Johannes Bruendl; Sami-Ramzi Leyh-Bannurah; Timur H Kuru; Karl-Friedrich Kowalewski; Daniel Schindele; Katharina S Mala; Niklas Westhoff; Andreas Blana; Martin Schostak Journal: World J Urol Date: 2021-04-21 Impact factor: 4.226