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EAU 2018

EAU 2018: Salvage Prostatectomy after Focal Therapy – Single Center Experience

Copenhagen, Denmark (UroToday.com) Dr. Herrera-Caceres from Toronto, Canada presented a single center experience of salvage radical prostatectomy after focal therapy. Over the past decade or so, focal therapy has emerged as an option for selected patients with localized prostate cancer who desire to potentially avoid side effects associated with radical treatment with the caveat of less mature oncologic outcomes. Although promising, there is a risk of treatment failure associated with focal therapy and some patients require secondary treatments such as salvage radical prostatectomy. Indeed, most salvage radical prostatectomy series are based on patients failing radiotherapy and not focal therapy. The objective of this study was to assess the outcomes of salvage radical prostatectomy after focal therapy, focusing on oncologic and functional outcomes.

The authors identified 34 patients from a prospectively maintained radical prostatectomy database who underwent prior focal therapy between 2006 and 2014. Focal therapy ablative modalities included: laser ablation (n=13), high-intensity focused ultrasound (HIFU; n=19), cryotherapy (n=1) and brachytherapy (n=1). The mean age of patients included in the study was 61 years. Disease persistence/recurrence was identified at the initial follow-up biopsy in 91.2% of cases (n=31), and the mean PSA prior to salvage radical prostatectomy was 5.38 ng/ml (SD 3.98); 28 (82.4%) of the salvage radical prostatectomy procedures were performed open. Fifty-six percent of patients had neurovascular bundle preservation of at least one side. No patients had rectal injury or thrombotic events, however two patients had incidental cystotomies during the operation. In 77% of the cases, dissection difficulties attributed to prior focal were mentioned in the surgical notes. Gleason group (GG) distribution of the salvage radical prostatectomy specimens was: GG 1 in 7 (20.9%), GG 2 in 20 (58.8%), GG 3 in 5 (14.7%), no GG 4, and GG 5 in 2 (5.9%). T stage distribution was pT2 (26.5%), pT3a (47.1%), and pT3b (11.8%). Nodal status was pNx (53%) and pN0 (47%), and 38% percent of specimens had positive surgical margins. Mean estimated blood loss was 512 ml (SD 396) and mean hospital length of stay was 2.5 days (SD 2.1). Post operatively, 8.8% of patients received adjuvant radiotherapy, and at a mean follow up of 4.3 years, 20.6% had biochemical recurrence; no patients have developed metastasis. In terms of functional outcomes, 31 (91.2%) patients were continent (1 pad/day) and one patient required an artificial urinary sphincter. All patients had some degree of erectile dysfunction, however 53% responded to medical therapy.

The authors concluded that in their single-center experience with salvage radical prostatectomy after focal therapy, reasonable oncological and functional outcomes are achievable with 4 years of follow-up, albeit inferior to primary radical prostatectomy. Similar to salvage radical prostatectomy after radiotherapy, this procedure should be considered as an option only in experienced centres.


Presented by: Jaime O. Herrera-Caceres

Co-Authors: Woon DTS, Goldberg H, Chandrasekar T, Klaassen Z, Fleshner N
Author Information:  Princess Margaret Cancer Centre, University Health Network, Toronto, Canada


Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, twitter: @zklaassen_md at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark