Salvage radical prostatectomy (sRP) has historically been associated with high morbidity, whilst recently published multicentre series suggested a trend towards improved outcomes. Hence, we performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria to investigate the oncological and functional results and morbidity of sRP. We included 20 retrospective articles comprising 4175 men. Robotic procedures were performed in 40% and nerve sparing in up to 36% of men. Postoperative continence was preserved in 40.4% of patients and erectile function in <16%. High-grade complications were described in 6.6% of patients (rectal injuries 0.9%). At final sRP pathology, surgical margins were positive in 26.1%, 32.8% had seminal vesicle invasion, and International Society of Urological Pathology grade was >3 in 26.6%. Ten-year metastasis-free survival ranged from 72% to 77% and 5-yr cancer-specific survival ranged from 86.6% to 97.7%. Salvage radical prostatectomy shows durable oncological control and morbidity improved over recent years, despite remaining significant compared to and higher than that of primary radical prostatectomy. PATIENT SUMMARY: Salvage radical prostatectomy (sRP) shows improving oncological control and morbidity over time. The complications associated with sRP and its functional results seem to be acceptable and are continuously improving.
European urology focus. 2023 Feb 21 [Epub ahead of print]
Giancarlo Marra, Alessandro Marquis, Takafumi Yanagisawa, Shahrokh F Shariat, Karim Touijer, Paolo Gontero
Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy. Electronic address: ., Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, Weill Cornell Medical College, New York, NY, USA., Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.