Minimally Invasive Salvage Prostatectomy after Primary Radiation or Ablation Treatment.

To analyze oncologic, functional and morbidity outcomes for patients undergoing minimally invasive salvage prostatectomy (MISP) at our institution.

Between 2001-2015, 5841 patients underwent radical prostatectomy at our institution, out of which 28 were MISP. Indications for MISP were PSA nadir + 2ng/dl in radio-recurrent patients and biopsy-proven PCa in other ablative treatments. We analyzed primary cancer characteristics, surgical data, perioperative complications, oncologic and functional outcomes of MISP, and further compared results between MISP after primary whole-gland (WT) and focal (FT) treatments.

Median age at salvage treatment was 65 (IQR 61-68). Compared to WT, MISP after FT had significantly lower operative time (133 vs. 176 min, p=0,001) and fewer upstaging (≥pT3a) (28% vs. 79%, p=0,008) at final pathology. Overall, PSM were noted in 4 patients (14%). Perioperative complications were observed in 9 patients with no difference between groups. At 12-months follow-up, 57% were continent and 33% had moderate to severe urinary leak. Potency was preserved in 6 out of 10 pre-operatively potent patients. Over a median follow-up of 62 months (IQR 43-110), 11 patients relapsed with a median time to BCR of 16 months (IQR 7-25). Recurrences were managed with salvage radiotherapy in 6 patients, 4 with hormone therapy and 1 CRPC. Overall, 24 patients are alive at last follow-up and 18 (72%) remain disease free.

MISP after primary radiation / ablation for PCa is feasible, safe with acceptable oncological outcomes. Compared to FT, MISP after WT appears to have longer operative time and more frequent upstaging.

Urology. 2016 May 03 [Epub ahead of print]

Estefania Linares Espinós, Rafael Sánchez-Salas, Arjun Sivaraman, Jose I Perez-Reggeti, Eric Barret, Francois Rozet, Marc Galiano, Dominique Prapotnich, Xavier Cathelineau

Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France.. Electronic address: ., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France., Department of Urology. Institut Montsouris, Université Paris-Descartes. Paris, France.