Romain Clery1, Pietro Grande1, Thomas Seisen1, Aurélien Gobert2, Igor Duquesne3, Arnauld Villers4, Jonathan Olivier4, Jean-Christophe Bernhard5, Grégoire Robert5, Jean Baptiste Beauval6, Thomas Prudhomme6, Franck Bruyère7, Paul Lainé-Caroff7, David Waltregny8, Bertrand Guillonneau9, Daniele Panarello9, Alain Ruffion10, Hubert De Bayser10, Alexandre de La Taille3, Morgan Roupret11. 1. Department of Urology, Sorbonne Université, GRC n5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 bvd hospital, 75013, Paris, France. 2. Department of Medical Oncology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France. 3. Department of Urology, Henri Mondor Hospital, AP-HP, CHU Mondor, Créteil, France. 4. Department of Urology, CHRU Lille, Lille University, Lille, France. 5. Department of Urology, Bordeaux University Hospital, Bordeaux, France. 6. Department of Urology, CHU Toulouse, Toulouse, France. 7. Department of Urology, CHU Tours, Tours, France. 8. Academic Department of Urology, University Hospital of Liege, Liege, Belgium. 9. Department of Urology, Simon Hospital, Diaconesses-Croix St, Paris, France. 10. Department of Urology, Lyon Sud Hospital, Pierre Bénite, Lyon, France. 11. Department of Urology, Sorbonne Université, GRC n5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 bvd hospital, 75013, Paris, France. morgan.roupret@aphp.fr.
Abstract
INTRODUCTION: Despite no consensus on the optimal management of recurrent prostate cancer after primary radiation or HIFU therapy, salvage prostatectomy (sRP) is reserved for only 3% of patients because of technical challenges and frequent post-operative complications. We assessed outcomes after sRP in a series of patients with localized PCa and that had received radiation therapy or HIFU as a first-line treatment. MATERIALS AND METHODS: Data from nine French referral centers on patients treated with sRP between 2005 and 2017 were collected. Pre- and post-operative data, including oncological and functional outcomes after first treatment and sRP, were analyzed to determine the predictors for biochemical recurrence (BCR) and cancer-specific survival (CSS) after sRP. RESULTS: First-line treatments were external beam-radiation therapy (EBRT) for 30 (55%), brachytherapy (BT) for 10 (18%), and high-intensity focused ultrasound (HIFU) for 15 (27%). Median (IQR) PSA at diagnosis was 6.4 (4.9-9.5) ng/mL, median PSA at nadir was 1.9 (0.7-3.0) ng/mL, and median (IQR) to first BCR was 13 (6-20) months. Of the 55 patients, 44 (80%) received robot-assisted salvage radical prostatectomy and 11 (20%) received salvage retropubic radical prostatectomy. Restoration of continence was achieved in 90% of preoperatively continent patients; 24% that had received nerve-sparing (NS) procedures were potent after surgery. Prolonged catheterization due to anastomotic leakage was the most common complication. Age, preoperative clinical stage, NS procedure, and a pathological Gleason score were predictors for BCR. CONCLUSIONS: sRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.
INTRODUCTION: Despite no consensus on the optimal management of recurrent prostate cancer after primary radiation or HIFU therapy, salvage prostatectomy (sRP) is reserved for only 3% of patients because of technical challenges and frequent post-operative complications. We assessed outcomes after sRP in a series of patients with localized PCa and that had received radiation therapy or HIFU as a first-line treatment. MATERIALS AND METHODS: Data from nine French referral centers on patients treated with sRP between 2005 and 2017 were collected. Pre- and post-operative data, including oncological and functional outcomes after first treatment and sRP, were analyzed to determine the predictors for biochemical recurrence (BCR) and cancer-specific survival (CSS) after sRP. RESULTS: First-line treatments were external beam-radiation therapy (EBRT) for 30 (55%), brachytherapy (BT) for 10 (18%), and high-intensity focused ultrasound (HIFU) for 15 (27%). Median (IQR) PSA at diagnosis was 6.4 (4.9-9.5) ng/mL, median PSA at nadir was 1.9 (0.7-3.0) ng/mL, and median (IQR) to first BCR was 13 (6-20) months. Of the 55 patients, 44 (80%) received robot-assisted salvage radical prostatectomy and 11 (20%) received salvage retropubic radical prostatectomy. Restoration of continence was achieved in 90% of preoperatively continent patients; 24% that had received nerve-sparing (NS) procedures were potent after surgery. Prolonged catheterization due to anastomotic leakage was the most common complication. Age, preoperative clinical stage, NS procedure, and a pathological Gleason score were predictors for BCR. CONCLUSIONS: sRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.
Authors: Patrick A Kenney; Cayce B Nawaf; Mahmoud Mustafa; Sijin Wen; Matthew F Wszolek; Curtis A Pettaway; John F Ward; John W Davis; Louis L Pisters Journal: Can J Urol Date: 2016-06 Impact factor: 1.344