Despite no consensus on the optimal management of recurrent prostate cancer after primary radiation or HIFU therapy, salvage prostatectomy (sRP) is reserved for only 3% of patients because of technical challenges and frequent post-operative complications. We assessed outcomes after sRP in a series of patients with localized PCa and that had received radiation therapy or HIFU as a first-line treatment.
Data from nine French referral centers on patients treated with sRP between 2005 and 2017 were collected. Pre- and post-operative data, including oncological and functional outcomes after first treatment and sRP, were analyzed to determine the predictors for biochemical recurrence (BCR) and cancer-specific survival (CSS) after sRP.
First-line treatments were external beam-radiation therapy (EBRT) for 30 (55%), brachytherapy (BT) for 10 (18%), and high-intensity focused ultrasound (HIFU) for 15 (27%). Median (IQR) PSA at diagnosis was 6.4 (4.9-9.5) ng/mL, median PSA at nadir was 1.9 (0.7-3.0) ng/mL, and median (IQR) to first BCR was 13 (6-20) months. Of the 55 patients, 44 (80%) received robot-assisted salvage radical prostatectomy and 11 (20%) received salvage retropubic radical prostatectomy. Restoration of continence was achieved in 90% of preoperatively continent patients; 24% that had received nerve-sparing (NS) procedures were potent after surgery. Prolonged catheterization due to anastomotic leakage was the most common complication. Age, preoperative clinical stage, NS procedure, and a pathological Gleason score were predictors for BCR.
sRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.
World journal of urology. 2019 Feb 21 [Epub ahead of print]
Romain Clery, Pietro Grande, Thomas Seisen, Aurélien Gobert, Igor Duquesne, Arnauld Villers, Jonathan Olivier, Jean-Christophe Bernhard, Grégoire Robert, Jean Baptiste Beauval, Thomas Prudhomme, Franck Bruyère, Paul Lainé-Caroff, David Waltregny, Bertrand Guillonneau, Daniele Panarello, Alain Ruffion, Hubert De Bayser, Alexandre de La Taille, Morgan Roupret
Department of Urology, Sorbonne Université, GRC n5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 bvd hospital, 75013, Paris, France., Department of Medical Oncology, AP-HP, Hôpital Pitié-Salpêtrière, 75013, Paris, France., Department of Urology, Henri Mondor Hospital, AP-HP, CHU Mondor, Créteil, France., Department of Urology, CHRU Lille, Lille University, Lille, France., Department of Urology, Bordeaux University Hospital, Bordeaux, France., Department of Urology, CHU Toulouse, Toulouse, France., Department of Urology, CHU Tours, Tours, France., Academic Department of Urology, University Hospital of Liege, Liege, Belgium., Department of Urology, Simon Hospital, Diaconesses-Croix St, Paris, France., Department of Urology, Lyon Sud Hospital, Pierre Bénite, Lyon, France., Department of Urology, Sorbonne Université, GRC n5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 83 bvd hospital, 75013, Paris, France. .