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Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review

  • Giancarlo Marra
  • Paolo Gontero
  • Jochen Christoph Walz
  • Arjun Sivaraman
  • Rafael Tourinho-Barbosa
  • Xavier Cathelineau
  • Rafael Sanchez-SalasEmail author
Topic Paper
  • 31 Downloads

Abstract

Background

Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown.

Objectives

To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT.

Materials and methods

A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an ‘a priori protocol’. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT.

Results

Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7–62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6–38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed.

Conclusions

Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.

Keywords

Focal therapy Prostate cancer Recurrence Salvage treatment Radiotherapy Radical prostatectomy 

Abbreviations

FT

Focal therapy for localized prostate cancer

PCa

Prostate cancer

RP

Radical prostatectomy

pRP

Primary radical prostatectomy

sRP

Salvage radical prostatectomy

mpMRI

Multiparametric magnetic resonance imaging

HIFU

High-intensity focused ultrasound

Notes

Author contributions

GM: protocol/project development, data collection and management, data analysis and manuscript writing. PG: data collection and management, manuscript editing, and manuscript review for important intellectual contents. JCW: manuscript editing and manuscript review for important intellectual contents. AS: manuscript editing and manuscript review for important intellectual contents. RT-B: manuscript editing and manuscript review for important intellectual contents. XC: manuscript editing and manuscript review for important intellectual contents. RS-S: protocol/project development, data collection and management, data analysis, manuscript editing and manuscript review for important intellectual contents.

Compliance with ethical standards

Conflict of interest

None to declare.

Research involving human participants and/or animals

None.

Informed consent

Not required (review article).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Giancarlo Marra
    • 1
  • Paolo Gontero
    • 1
  • Jochen Christoph Walz
    • 2
  • Arjun Sivaraman
    • 3
  • Rafael Tourinho-Barbosa
    • 4
  • Xavier Cathelineau
    • 4
  • Rafael Sanchez-Salas
    • 4
    Email author
  1. 1.Department of Urology, San Giovanni Battista HospitalCittà Della Salute e della Scienza and University of TurinTurinItaly
  2. 2.Department of UrologyInstitut Paoli-CalmettesMarseilleFrance
  3. 3.Department of UrologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  4. 4.Department of UrologyInstitut Mutualiste Montsouris and Université Paris DescartesParisFrance

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