Advertisement

Outcomes after salvage radical prostatectomy and first-line radiation therapy or HIFU for recurrent localized prostate cancer: results from a multicenter study

  • Romain Clery
  • Pietro Grande
  • Thomas Seisen
  • Aurélien Gobert
  • Igor Duquesne
  • Arnauld Villers
  • Jonathan Olivier
  • Jean-Christophe Bernhard
  • Grégoire Robert
  • Jean Baptiste Beauval
  • Thomas Prudhomme
  • Franck Bruyère
  • Paul Lainé-Caroff
  • David Waltregny
  • Bertrand Guillonneau
  • Daniele Panarello
  • Alain Ruffion
  • Hubert De Bayser
  • Alexandre de La Taille
  • Morgan RoupretEmail author
Topic Paper
  • 45 Downloads

Abstract

Introduction

Despite no consensus on the optimal management of recurrent prostate cancer after primary radiation or HIFU therapy, salvage prostatectomy (sRP) is reserved for only 3% of patients because of technical challenges and frequent post-operative complications. We assessed outcomes after sRP in a series of patients with localized PCa and that had received radiation therapy or HIFU as a first-line treatment.

Materials and methods

Data from nine French referral centers on patients treated with sRP between 2005 and 2017 were collected. Pre- and post-operative data, including oncological and functional outcomes after first treatment and sRP, were analyzed to determine the predictors for biochemical recurrence (BCR) and cancer-specific survival (CSS) after sRP.

Results

First-line treatments were external beam-radiation therapy (EBRT) for 30 (55%), brachytherapy (BT) for 10 (18%), and high-intensity focused ultrasound (HIFU) for 15 (27%). Median (IQR) PSA at diagnosis was 6.4 (4.9–9.5) ng/mL, median PSA at nadir was 1.9 (0.7–3.0) ng/mL, and median (IQR) to first BCR was 13 (6–20) months. Of the 55 patients, 44 (80%) received robot-assisted salvage radical prostatectomy and 11 (20%) received salvage retropubic radical prostatectomy. Restoration of continence was achieved in 90% of preoperatively continent patients; 24% that had received nerve-sparing (NS) procedures were potent after surgery. Prolonged catheterization due to anastomotic leakage was the most common complication. Age, preoperative clinical stage, NS procedure, and a pathological Gleason score were predictors for BCR.

Conclusions

sRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.

Keywords

Prostate neoplasm Salvage Recurrence: radiation therapy Radical prostatectomy Survival 

Notes

Author contributions

MR, AT protocol/project development. RC, ID, JO, GR, TP, PL-C, HB, DP data collection or management. TS, PG data analysis. RC, PG, MR, TS, AT, AG, AV, J-CB, JBB, FB, DW, BG, AR manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

The authors have disclosed any potential conflicts of interests.

Informed consent

All patients gave their written informed consent to be included in the prostate-cancer database at each center.

Ethical approval

All patients' anonymity was preserved. All authors made significant contributions to the findings and methods in the paper, and have read and approved the final draft. The hospital's Ethics Committees approval was obtained and conformed to the provisions of the Declaration of Helsinki.

References

  1. 1.
    Rozet F, Hennequin C, Beauval J-B, Beuzeboc P, Cormier L, Fromont G et al (2016) Recommandations en onco-urologie 2016–2018 du CCAFU: cancer de la prostate. Prog En Urol 27:S95–S143Google Scholar
  2. 2.
    Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68(1):7–30Google Scholar
  3. 3.
    Cooperberg MR, Modak S, Konety BR (2007) Trends in Regionalization of inpatient care for urological malignancies, 1988–2002. J Urol 178:2103–2108Google Scholar
  4. 4.
    Mottet N, Bellmunt J, Bolla M, Briers E, Cumberbatch MG, De Santis M et al (2016) EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol 71:1–12Google Scholar
  5. 5.
    Roach M, Hanks G, Thames H, Schellhammer P, Shipley WU, Sokol GH et al (2006) Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: recommendations of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 65(4):965–974Google Scholar
  6. 6.
    Bates AS, Samavedi S, Kumar A, Mouraviev V, Rocco B, Coelho R et al (2015) Salvage robot assisted radical prostatectomy: a propensity matched study of perioperative, oncological and functional outcomes. Eur J Surg Oncol 41(11):1540–1546Google Scholar
  7. 7.
    Rocco B, Cozzi G, Spinelli MG, Grasso A, Varisco D, Coelho RF et al (2012) Current status of salvage robot-assisted laparoscopic prostatectomy for radiorecurrent prostate cancer. Curr Urol Rep 13(3):195–201Google Scholar
  8. 8.
    Abdul-Muhsin H, Samavedi S, Pereira C, Palmer K, Patel V (2013) Salvage robot-assisted radical prostatectomy. BJU Int 111(4):686–687Google Scholar
  9. 9.
    Ogaya-Pinies G, Linares-Espinos E, Hernandez-Cardona E, Jenson C, Cathelineau X, Sanchez-Salas R et al (2018) Salvage robotic-assisted radical prostatectomy: oncologic and functional outcomes from two high-volume institutions. World J Urol.  https://doi.org/10.1007/s00345-018-2406-4 Google Scholar
  10. 10.
    Gotto GT, Yunis LH, Vora K, Eastham JA, Scardino PT, Rabbani F (2010) Impact of prior prostate radiation on complications after radical prostatectomy. J Urol 184(1):136–142Google Scholar
  11. 11.
    Stephenson AJ, Scardino PT, Bianco FJ, Diblasio CJ, Fearn PA, Eastham JA (2004) Morbidity and functional outcomes of salvage radical prostatectomy for locally recurrent prostate cancer after radiation therapy. J Urol 172(6):2239–2243Google Scholar
  12. 12.
    Darras J, Joniau S, Van Poppel H (2006) Salvage radical prostatectomy for radiorecurrent prostate cancer: indications and results. Eur J Surg Oncol EJSO 32(9):964–969Google Scholar
  13. 13.
    Gill I, Cacciamani G (2018) LBA3 the changing face of urologic oncologic surgery from 2000–2018 (63,141 patients)—impact of robotics. J Urol 199(4):e577–e578Google Scholar
  14. 14.
    Klayton TL, Ruth K, Buyyounouski MK, Uzzo RG, Wong Y-N, Chen DYT et al (2011) Prostate-specific antigen doubling time predicts the development of distant metastases for patients who fail 3-dimensional conformal radiotherapy or intensity modulated radiation therapy using the Phoenix definition. Pract Radiat Oncol 1(4):235–242Google Scholar
  15. 15.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213Google Scholar
  16. 16.
    Mador DR, Huben RP, Wajsman Z, Pontes JE (1985) Salvage surgery following radical radiotherapy for adenocarcinoma of the prostate. J Urol 133(1):58–60Google Scholar
  17. 17.
    Kenney PA, Nawaf CB, Mustafa M, Wen S, Wszolek MF, Pettaway CA et al (2016) Robotic-assisted laparoscopic versus open salvage radical prostatectomy following radiotherapy. Can J Urol 23(3):8271–8277Google Scholar
  18. 18.
    Yuh B, Ruel N, Muldrew S, Mejia R, Novara G, Kawachi M et al (2014) Complications and outcomes of salvage robot-assisted radical prostatectomy: a single-institution experience. BJU Int 113(5):769–776Google Scholar
  19. 19.
    Kaffenberger SD, Keegan KA, Bansal NK, Morgan TM, Tang DH, Barocas DA et al (2013) Salvage robotic assisted laparoscopic radical prostatectomy: a single institution, 5-year experience. J Urol 189(2):507–513Google Scholar
  20. 20.
    Zugor V, Labanaris AP, Porres D, Heidenreich A, Witt JH (2014) Robot-assisted radical prostatectomy for the treatment of radiation-resistant prostate cancer: surgical, oncological and short-term functional outcomes. Urol Int 92(1):20–26Google Scholar
  21. 21.
    Eandi JA, Link BA, Nelson RA, Josephson DY, Lau C, Kawachi MH et al (2010) Robotic assisted laparoscopic salvage prostatectomy for radiation resistant prostate cancer. J Urol 183(1):133–137Google Scholar
  22. 22.
    Matei DV, Ferro M, Jereczek-Fossa BA, Renne G, Crisan N, Bottero D et al (2015) Salvage radical prostatectomy after external beam radiation therapy: a systematic review of current approaches. Urol Int 94(4):373–382Google Scholar
  23. 23.
    Mandel P, Steuber T, Ahyai S, Kriegmair M, Schiffmann J, Boehm K et al (2016) Salvage radical prostatectomy for recurrent prostate cancer: verification of European Association of Urology guideline criteria. BJU Int 117(1):55–61Google Scholar
  24. 24.
    Kaouk JH, Hafron J, Goel R, Haber G-P, Jones JS (2008) Robotic salvage retropubic prostatectomy after radiation/brachytherapy: initial results. BJU Ints 102(1):93–96Google Scholar

Copyright information

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

Authors and Affiliations

  • Romain Clery
    • 1
  • Pietro Grande
    • 1
  • Thomas Seisen
    • 1
  • Aurélien Gobert
    • 2
  • Igor Duquesne
    • 3
  • Arnauld Villers
    • 4
  • Jonathan Olivier
    • 4
  • Jean-Christophe Bernhard
    • 5
  • Grégoire Robert
    • 5
  • Jean Baptiste Beauval
    • 6
  • Thomas Prudhomme
    • 6
  • Franck Bruyère
    • 7
  • Paul Lainé-Caroff
    • 7
  • David Waltregny
    • 8
  • Bertrand Guillonneau
    • 9
  • Daniele Panarello
    • 9
  • Alain Ruffion
    • 10
  • Hubert De Bayser
    • 10
  • Alexandre de La Taille
    • 3
  • Morgan Roupret
    • 1
    Email author
  1. 1.Department of UrologySorbonne Université, GRC n5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-SalpêtrièreParisFrance
  2. 2.Department of Medical OncologyAP-HP, Hôpital Pitié-SalpêtrièreParisFrance
  3. 3.Department of UrologyHenri Mondor Hospital, AP-HP, CHU MondorCréteilFrance
  4. 4.Department of UrologyCHRU Lille, Lille UniversityLilleFrance
  5. 5.Department of UrologyBordeaux University HospitalBordeauxFrance
  6. 6.Department of UrologyCHU ToulouseToulouseFrance
  7. 7.Department of UrologyCHU ToursToursFrance
  8. 8.Academic Department of UrologyUniversity Hospital of LiegeLiegeBelgium
  9. 9.Department of UrologySimon HospitalParisFrance
  10. 10.Department of UrologyLyon Sud HospitalLyonFrance

Personalised recommendations