Is the Toxicity of Salvage Prostatectomy Related to the Primary Prostate Cancer Therapy Received?

PURPOSE To compare the toxicity profile and oncological outcome of salvage radical prostatectomy (SRP) following focal therapy (FT) versus SRP after radiation therapies (RT) - external beam radiation therapy (EBRT) or brachytherapy (BT). MATERIALS AND METHODS Data concerning all men undergoing SRP for recurrent prostate cancer after either FT, EBRT or BT were retrospectively collected from 4 high volume surgical centres. The primary outcome measure of the study was toxicity of SRP characterized by any 30-day post-operative Clavien-Dindo complication rate, 12-month continence rate and 12-month potency rate. The secondary outcome was oncological outcome after SRP including positive margin rate and 12-month biochemical recurrence (BCR) rate. BCR was estimated using Kaplan-Meier methods and significant differences were calculated using a log rank test. Median follow-up time was 29.5 months. RESULTS Between April 2007 and September 2018, 185 patients underwent SRP of which 95 had SRP after FT and 90 had SRP after RT, either EBRT or BT. SRP after RT was associated with a significantly higher 30-day Clavien-Dindo I-IV complication rate (34% vs 5%, p<0.001). At 12 months following surgery, patients undergoing SRP after FT had significantly better continence (SRP after FT:83% pad-free vs RT:49%) while potency outcomes were similar (FT:14% vs RT:11%). Men undergoing SRP after RT had a significantly higher stage and grade of disease together with a higher positive surgical margin rate (37% vs 13%, p=0.001). 3-year BCR after FT was 35% compared to 32% after RT, p=0.76. In multivariable analysis, men undergoing SRP after FT experienced a higher risk of BCR (HR 0.36 [0.18-0.82], p<0.005). CONCLUSIONS This multicentre study demonstrates the toxicity of SRP in terms of perioperative complications and long-term urinary continence recovery is dependent on initial primary prostate cancer therapy received with men undergoing SRP after FT experiencing lower postoperative complication rates and better urinary continence outcomes.

[1]  H. Ahmed,et al.  Evaluating the Trade-offs Men with Localised Prostate Cancer Make Between the Risks and Benefits of Treatments: The COMPARE Study. , 2020, The Journal of urology.

[2]  V. Patel,et al.  Comparison of outcomes of salvage robot‐assisted laparoscopic prostatectomy for post‐primary radiation vs focal therapy , 2020, BJU international.

[3]  M. Emberton,et al.  Salvage Local Treatments After Focal Therapy for Prostate Cancer. , 2019, European urology oncology.

[4]  F. Montorsi,et al.  Medium‐term oncological outcomes in a large cohort of men treated with either focal or hemi‐ablation using high‐intensity focused ultrasonography for primary localized prostate cancer , 2019, BJU international.

[5]  H. Ahmed,et al.  Robot-assisted Radical Prostatectomy After Focal Therapy: Oncological, Functional Outcomes and Predictors of Recurrence. , 2019, European urology.

[6]  A. Sidana,et al.  Salvage treatment for radio-recurrent prostate cancer: a review of literature with focus on recent advancements in image-guided focal salvage therapies , 2019, International Urology and Nephrology.

[7]  Raj Persad,et al.  A Multicentre Study of 5-year Outcomes Following Focal Therapy in Treating Clinically Significant Nonmetastatic Prostate Cancer , 2018, European urology.

[8]  H. Samaratunga,et al.  Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. , 2018, The Lancet. Oncology.

[9]  V. Patel,et al.  Salvage robotic-assisted radical prostatectomy: oncologic and functional outcomes from two high-volume institutions , 2018, World Journal of Urology.

[10]  J. Pow-Sang,et al.  Salvage robotic prostatectomy for radio recurrent prostate cancer: technical challenges and outcome analysis. , 2017, Minerva urologica e nefrologica = The Italian journal of urology and nephrology.

[11]  E. Barret,et al.  Minimally Invasive Salvage Prostatectomy After Primary Radiation or Ablation Treatment. , 2016, Urology.

[12]  Nathan Lawrentschuk,et al.  The Role of Focal Therapy in the Management of Localised Prostate Cancer: A Systematic Review , 2014, European urology.

[13]  S. Kaffenberger,et al.  Salvage robotic radical prostatectomy , 2014, Indian Journal of Urology.

[14]  G. Novara,et al.  Complications and outcomes of salvage robot‐assisted radical prostatectomy: a single‐institution experience , 2014, BJU international.

[15]  N. Vasdev,et al.  Post-radical prostatectomy incontinence: etiology and prevention. , 2014, Reviews in urology.

[16]  A. Heidenreich,et al.  Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes , 2013, Urologia Internationalis.

[17]  S. Herrell,et al.  Salvage robotic assisted laparoscopic radical prostatectomy: a single institution, 5-year experience. , 2012, The Journal of urology.

[18]  Tyler R. McClintock,et al.  Short-, Intermediate-, and Long-term Quality of Life Outcomes Following Radical Prostatectomy for Clinically Localized Prostate Cancer. , 2013, Reviews in urology.

[19]  P. Scardino,et al.  Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. , 2012, European urology.

[20]  H. G. van der Poel,et al.  Salvage radical prostatectomy for radiation-recurrent prostate cancer: a multi-institutional collaboration. , 2011, European urology.

[21]  潘悦.  Focal Therapy for Localized Prostate Cancer , 2009 .

[22]  P. Scardino,et al.  Oncologic outcome and patterns of recurrence after salvage radical prostatectomy. , 2009, European urology.

[23]  L. Pisters.  Treatment failure after primary and salvage therapy for prostate cancer , 2008, Cancer.

[24]  P. Scardino,et al.  Salvage radical prostatectomy: outcome measured by serum prostate specific antigen levels. , 1995, The Journal of urology.