EAU 2018: Oncological Outcome of Radical Salvage Prostatectomy in a Large Contemporary Series
The study included 262 patients with radio-recurrence prostate cancer who underwent SRP at two high volume referral centers from 2000 to 2016. All patients underwent metastatic work-up conventional imaging (CT scan and bone scans), 53 pts undergoing further evaluation with PSMA-PET/CT. A transrectal or trans-perineal prostate biopsy was obtained in all patients to confirm a local relapse. The primary goals of the study were to assess the impact of SRP on oncological outcomes mainly biochemical-free survival. Of the patients who underwent resection, 45% had localized disease (pT2a-c). The positive margin was high at 33%, but this was expected given the challenging nature of the case and the advanced stage in more than half of the cohort. Nodal involvement was observed in approximately 40% of the cohort, increasing pathological stage being the best predictor of nodal involvement. At a median follow-up of 45.6 months, 53% of the cohort remained without biochemical recurrence (BCR), the great majority being those with localized node-negative disease (71.4%). Interestingly, almost 40% of the patients with nodal involvement remained BRC NED following lymphadenectomy, without the need for hormonal treatments.
The procedure was found to be safe with a complication rate of ~ 9.1%, most of the complications being minor (Clavein 1-3). The risk of anastomotic leakage was 5.3%, with none of the patients developing a bladder neck contracture. At 6-month follow-up, 35% of the patients were fully continent, with 39% and 25% reporting moderate and severe incontinence, respectively. Potency rates were not reported by the authors.
Subset analysis of those undergoing PSMA-PET showed that the imaging technique had a 97.4% accuracy at identifying intraprostatic relapse, but only an 80% accuracy at identifying nodal recurrences.
In summary, SRP can provide excellent long-term oncological outcomes results with low surgery-associated morbidity in experienced tertiary referral centers. Patients with organ-confined node-negative disease have the best oncological outcomes. PSMA-PET is highly predictive of intraprostatic relapse but was inferior at predicting nodal involvement.
Presented by: Professor Axel Heidenreich MD, University Hospital of Cologne, Germany
Written by: Andres F. Correa, Urologic Oncology Fellow, Fox Chase Cancer Center, Philadelphia, PA at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark