Giancarlo Marra1, Robert Jeffrey Karnes2, Giorgio Calleris3, Marco Oderda3, Paolo Alessio3, Anna Palazzetti3, Antonino Battaglia4, Francesca Pisano5, Stefania Munegato3, Fernando Munoz6, Claudia Filippini7, Umberto Ricardi8, Estefania Linares9, Rafael Sanchez-Salas9, Sanchia Goonewardene10, Prokar Dasgupta10, Ben Challacombe10, Rick Popert10, Declan Cahill11, David Gillatt12, Raj Persad12, Juan Palou13, Steven Joniau14, Salvatore Smelzo15, Thierry Piechaud15, Alexandre De La Taille16, Morgan Roupret17, Simone Albisinni18, Roland van Velthoven18, Alessandro Morlacco2, Sharma Vidit2, Giorgio Gandaglia19, Alexander Mottrie19, Joseph Smith20, Shreyas Joshi20, Gabriel Fiscus20, Andre Berger21, Monish Aron21, Andre Abreu21, Inderbir S Gill21, Henk Van Der Poel22, Derya Tilki23, Declan Murphy24, Nathan Lawrentschuk24, John Davis25, Paolo Gontero3. 1. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy; Department of Urology, Institut Mutualiste Montsouris, Paris, France. Electronic address: drgiancarlomarra@gmail.com. 2. Department of Urology, Mayo Clinic, Rochester, MN. 3. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy. 4. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy; Department of Urology, Leuven University Hospitals, Leuven, Belgium. 5. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy; Department of Urology, Fundaciò Puigvert, Barcelona, Spain. 6. Department of Radiotherapy, Pasini Hospital, Aosta, Italy. 7. Department of Statistics, University of Turin, Turin, Italy. 8. Department of Radiotherapy and School of Medicine Chair, University of Turin, Turin, Italy. 9. Department of Urology, Institut Mutualiste Montsouris, Paris, France. 10. Department of Urology, Urology Centre, Guy's Hospital, London, UK. 11. Department of Urology, Royal Marsden Hospital, London, UK. 12. Department of Urology, Bristol NHS Foundation Trust, Bristol, UK. 13. Department of Urology, Fundaciò Puigvert, Barcelona, Spain. 14. Department of Urology, Leuven University Hospitals, Leuven, Belgium. 15. Department of Urology, Clinique Saint Augustin, Bordeaux, France. 16. Department of Urology, CHU Mondor, Créteil, France. 17. Department of Urology, Pitié Salpétrière Hospital University Paris 6, Paris, France. 18. Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium. 19. Department of Urology, OLV Hospital, Aalst, Belgium. 20. Department of Urology, Vanderbilt University, Medical Center North, Nashville, TN, USA. 21. Department of Urology, USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, CA. 22. Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands. 23. Department of Urology, Martini Klinik, Hamburg, Germany. 24. Department of Urology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 25. Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND: Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP show improved results. Our objectives were to evaluate sRP oncological outcomes and predictors of positive margins and biochemical recurrence (BCR). METHODS: We retrospectively collected data of sRP for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers in United States, Australia and Europe, from 2000 to 2016. SM and BCR were evaluated in a univariate and multivariable analysis. Overall and cancer-specific survival were also assessed. RESULTS: We included 414 cases, 63.5% of them performed after radiotherapy. Before sRP the majority of patients had biopsy Gleason score (GS) ≤7 (55.5%) and imaging negative or with prostatic bed involvement only (93.3%). Final pathology showed aggressive histology in 39.7% (GS ≥9 27.6%), with 52.9% having ≥pT3 disease and 16% pN+. SM was positive in 29.7%. Five years BCR-Free, cancer-specific survival and OS were 56.7%, 97.7% and 92.1%, respectively. On multivariable analysis pathological T (pT3a odds ratio [OR] 2.939, 95% confidence interval [CI] 1.469-5.879; ≥pT3b OR 2.428-95% CI 1.333-4.423) and N stage (pN1 OR 2.871, 95% CI 1.503-5.897) were independent predictors of positive margins. Pathological T stage ≥T3b (OR 2.348 95% CI 1.338-4.117) and GS (up to OR 7.183, 95% CI 1.906-27.068 for GS >8) were independent predictors for BCR. Limitations include the retrospective nature of the study and limited follow-up. CONCLUSIONS: In a contemporary series, sRP showed promising oncological control in the medium term despite aggressive pathological features. BCR risk increased in case of locally advanced disease and higher GS. Future studies are needed to confirm our findings.
BACKGROUND: Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP show improved results. Our objectives were to evaluate sRP oncological outcomes and predictors of positive margins and biochemical recurrence (BCR). METHODS: We retrospectively collected data of sRP for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers in United States, Australia and Europe, from 2000 to 2016. SM and BCR were evaluated in a univariate and multivariable analysis. Overall and cancer-specific survival were also assessed. RESULTS: We included 414 cases, 63.5% of them performed after radiotherapy. Before sRP the majority of patients had biopsy Gleason score (GS) ≤7 (55.5%) and imaging negative or with prostatic bed involvement only (93.3%). Final pathology showed aggressive histology in 39.7% (GS ≥9 27.6%), with 52.9% having ≥pT3 disease and 16% pN+. SM was positive in 29.7%. Five years BCR-Free, cancer-specific survival and OS were 56.7%, 97.7% and 92.1%, respectively. On multivariable analysis pathological T (pT3a odds ratio [OR] 2.939, 95% confidence interval [CI] 1.469-5.879; ≥pT3b OR 2.428-95% CI 1.333-4.423) and N stage (pN1 OR 2.871, 95% CI 1.503-5.897) were independent predictors of positive margins. Pathological T stage ≥T3b (OR 2.348 95% CI 1.338-4.117) and GS (up to OR 7.183, 95% CI 1.906-27.068 for GS >8) were independent predictors for BCR. Limitations include the retrospective nature of the study and limited follow-up. CONCLUSIONS: In a contemporary series, sRP showed promising oncological control in the medium term despite aggressive pathological features. BCR risk increased in case of locally advanced disease and higher GS. Future studies are needed to confirm our 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