Salvage Radical Prostatectomy for Recurrent Prostate Cancer Following First-line Nonsurgical Treatment: Validation of the European Association of Urology Criteria in a Large, Multicenter, Contemporary Cohort.

Salvage radical prostatectomy (sRP) is a potentially curative option for locally radiorecurrent prostate cancer (PCa) but is associated with significant morbidity. Therefore, the European Association of Urology (EAU) guidelines recommend restricting sRP to a favorable-prognosis group according to the EAU criteria, but these have been validated considering only biochemical recurrence (BCR). Our aim was to test these criteria in a large, multicenter, contemporary cohort. We retrospectively reviewed 1265 patients who underwent sRP at 14 referral centers (2000-2021), stratified by compliance with the EAU criteria. Our primary outcome was metastasis-free survival (MFS). We included 1030 men, of whom 221 (21.5%) fully met the EAU recommended criteria for sRP and 809 (78.5%) did not. The EAU-compliant group experienced more favorable pathological and functional outcomes (79% vs 63% wearing no pads at 1 yr; p < 0.001) and had significantly better MFS (90% vs 76% at 5 yr; p < 0.001), prostate-specific antigen-free survival (55% vs 38% at 5 yr; p < 0.001), and overall survival (89% vs 84% at 5 yr; p = 0.01). This was verified by Cox regression analysis for MFS (hazard ratio 1.84, 95% confidence interval 1.13-2.99; p = 0.01). We found that adherence to the EAU criteria is associated with a lower risk of BCR and, more importantly, of metastasis after surgery. PATIENT SUMMARY: We looked at outcomes of surgical removal of the prostate for prostate cancer recurrence after radiotherapy or other nonsurgical treatments according to whether or not patients met the European Association of Urology (EAU) criteria for this surgery. We found that men who did not meet the criteria had a higher risk of metastasis and their benefit from surgery might be significantly less than for patients who do meet the EUA criteria.

European urology focus. 2023 Jan 20 [Epub ahead of print]

Giorgio Calleris, Giancarlo Marra, Nicole Benfant, Pawel Rajwa, Mohamed Ahmed, Andre Abreu, Giovanni Cacciamani, Alireza Ghoreifi, Luis Ribeiro, Thilo Westhofen, Rafael Tourinho-Barbosa, Yannic Raskin, Hans Veerman, Simone Albisinni, Joseph A Smith, Morgan Rouprêt, Marco Oderda, Emilia Massari, Raj Persad, Henk Van Der Poel, Steven Joniau, Rafael Sanchez-Salas, Alexander Kretschmer, Paul Cathcart, Inderbir Gill, R Jeffrey Karnes, Derya Tilki, Shahrokh F Shariat, Karim Touijer, Paolo Gontero

Urology Clinic, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy., Urology Clinic, Department of Surgical Sciences, University of Turin and Città della Salute e della Scienza, Turin, Italy. Electronic address: ., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Medical University of Silesia, Zabrze, Poland., Department of Urology, Mayo Clinic, Rochester, MN, USA., USC Institute of Urology & The Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA., Urology Centre, Guy's Hospital, London, UK., Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany., Department of Urology, Institut Mutualiste Montsouris and Université Paris Descartes, Paris, France., Department of Urology, University Hospitals Leuven, Leuven, Belgium., Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium., Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Sorbonne University, GRC 5 Predictive Onco-Uro, Department of Urology, Pitie-Salpetriere Hospital, AP-HP, Paris, France., North Bristol NHS Trust, Bristol, UK., Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey., Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.