Outcomes after salvage radical prostatectomy and first-line radiation therapy or HIFU for recurrent localized prostate cancer: results from a multicenter study
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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.
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.
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.
KeywordsProstate neoplasm Salvage Recurrence: radiation therapy Radical prostatectomy Survival
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.
All patients gave their written informed consent to be included in the prostate-cancer database at each center.
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.
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