Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review.

Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown.

To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT.

A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an 'a priori protocol'. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT.

Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7-62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6-38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed.

Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.

World journal of urology. 2019 Feb 01 [Epub ahead of print]

Giancarlo Marra, Paolo Gontero, Jochen Christoph Walz, Arjun Sivaraman, Rafael Tourinho-Barbosa, Xavier Cathelineau, Rafael Sanchez-Salas

Department of Urology, San Giovanni Battista Hospital, Città Della Salute e della Scienza and University of Turin, Turin, Italy., Department of Urology, Institut Paoli-Calmettes, Marseille, France., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA., Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France., Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France. .