Radical prostatectomy after vascular-targeted photodynamic therapy (VTP) with TOOKAD® : feasibility, early and intermediate results.

and objectives: vascular-targeted photodynamic therapy with TOOKAD® (VTP) is a new therapeutic option for localized prostate cancer (PCa) management. The objectives are to assess the feasibility of radical prostatectomy (RP) after VTP and describe functional and oncological outcomes.

we retrospectively included 45 patients who underwent salvage RP after VTP for recurrent PCa in 14 surgical centres in Europe between October 2008 and March 2017.Forty-two RP were performed: 16 robot-assisted, 6 by laparoscopy, and 20 by open surgery. Primary endpoints were morbidity and technical difficulties. Secondary endpoints were early and intermediate post-operative functional and oncologic outcomes.

Median operative time was 180 (150-223) minutes. Median blood loss was 200 (155-363) millilitres. According to the surgeons, the surgery was "easy" for 29 patients (69%), "difficult" for 13 patients (31%). Nerve sparing was feasible for 14 patients (33%). Five (12%) post-operative complications were found: 2 Claviens I, 2 Clavien II and 1 Clavien IIIB. There was 13 pT3 (31%), 21 (50%) pT2c. Surgical margins were positive for 13 patients (31%). PSA was undetectable at 6-12 months for 37 patients (88%). Nine patients had complementary radiotherapy. Four patients had a last PSA > 0.2 ng/mL with a median follow-up of 23 (12-36) months. At one year, 27 patients (64%) were completely continent (no pads), 10 (24%) had low incontinence (1 pads). Four patients (11 %) recovered potency without treatment, and 23 (64%) with appropriate treatment.

Salvage RP after VTP treatment was feasible and safe without difficulties for most of the surgeons.

The Journal of urology. 2018 Sep 21 [Epub ahead of print]

V Pierrard, S Lebdai, F Kleinclauss, A-R Azzouzi, J E Terrier, E Fortier, S Joniau, H Van Der Poel, G Salomon, J Casanova, R-A Medina-Lopez, E Potiron, J Rigaud, S Vincendeau, J Rassweiler, A Villers, R Gaston, C Saussine, J Giai, B Gaillac, M Emberton, A Ruffion

Lyon Sud University Hospital, Urology, Lyon, France., Angers Universitary Hospital, Urology, Angers, France., Hospital Center, Urology, Besançon, France., Hospital Center, Urology, Leuven, Belgium., Antoni Van Leeuwenhoek Hospital, Urology, Amsterdam, Netherlands., Spire Portsmouth Hospital, Urology, Hamburg, Germany., Hospital Center, Urology, Valencia, Spain., Virgen del Rocío University Hospital. Department of urology, Sevilla. Spain., Atlantis Clinic, Urology, Nantes, France., Nantes University Hospital, Urology, Nantes, France., Rennes Universitary Hospital, Urology, Rennes, France., SLK Kliniken, Department of Urology, Heilbronn, Germany., Lille University Hospital , Urology, Lille, France., Saint Augustin Clinic, Bordeaux, France., Strasbourg University hospital, Urology, Strasbourg, France., Lyon Sud University Hospital, Department of biostatistics, Lyon, France., STEBA France, Paris, France., Division of Surgery and Interventional Science, University College London, London, UK.