Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

Jaime O. Herrera-Caceres, Gregory J. Nason, Noelia Salgado-Sanmamed, Hanan Goldberg, Dixon T.S. Woon, Thenappen Chandrasekar, Khaled Ajib, Guan Hee Tan, Omar Alhunaidi, Theodorus van der Kwast, Antonio Finelli, Alexandre R. Zlotta, Robert J. Hamilton, Alejandro Berlin, Nathan Perlis, Neil E. Fleshner

Research output: Contribution to journalArticle

Abstract

Objectives: To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). Patients and Methods: A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. Results: In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243–19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5–9.5) and 23.5 (15.75–25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5–11) and 6 (5–12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. Conclusions: sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.

Original languageEnglish
JournalBJU International
DOIs
Publication statusAccepted/In press - 1 Jan 2019

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Prostatectomy
Therapeutics
Recurrence
Incontinence Pads
Cystotomy
Artificial Urinary Sphincter
Adjuvant Radiotherapy
Cryotherapy
Brachytherapy
Laser Therapy
Contracture
Length of Stay
Prostatic Neoplasms
Urinary Bladder
Radiotherapy
Confidence Intervals
Survival

Keywords

  • #PCSM
  • #ProstateCancer
  • focal therapy
  • high-intensity focussed ultrasound
  • prostate cancer
  • recurrence
  • salvage prostatectomy

ASJC Scopus subject areas

  • Urology

Cite this

Herrera-Caceres, J. O., Nason, G. J., Salgado-Sanmamed, N., Goldberg, H., Woon, D. T. S., Chandrasekar, T., ... Fleshner, N. E. (Accepted/In press). Salvage radical prostatectomy following focal therapy: functional and oncological outcomes. BJU International. https://doi.org/10.1111/bju.14976

Salvage radical prostatectomy following focal therapy : functional and oncological outcomes. / Herrera-Caceres, Jaime O.; Nason, Gregory J.; Salgado-Sanmamed, Noelia; Goldberg, Hanan; Woon, Dixon T.S.; Chandrasekar, Thenappen; Ajib, Khaled; Tan, Guan Hee; Alhunaidi, Omar; van der Kwast, Theodorus; Finelli, Antonio; Zlotta, Alexandre R.; Hamilton, Robert J.; Berlin, Alejandro; Perlis, Nathan; Fleshner, Neil E.

In: BJU International, 01.01.2019.

Research output: Contribution to journalArticle

Herrera-Caceres, JO, Nason, GJ, Salgado-Sanmamed, N, Goldberg, H, Woon, DTS, Chandrasekar, T, Ajib, K, Tan, GH, Alhunaidi, O, van der Kwast, T, Finelli, A, Zlotta, AR, Hamilton, RJ, Berlin, A, Perlis, N & Fleshner, NE 2019, 'Salvage radical prostatectomy following focal therapy: functional and oncological outcomes', BJU International. https://doi.org/10.1111/bju.14976
Herrera-Caceres JO, Nason GJ, Salgado-Sanmamed N, Goldberg H, Woon DTS, Chandrasekar T et al. Salvage radical prostatectomy following focal therapy: functional and oncological outcomes. BJU International. 2019 Jan 1. https://doi.org/10.1111/bju.14976
Herrera-Caceres, Jaime O. ; Nason, Gregory J. ; Salgado-Sanmamed, Noelia ; Goldberg, Hanan ; Woon, Dixon T.S. ; Chandrasekar, Thenappen ; Ajib, Khaled ; Tan, Guan Hee ; Alhunaidi, Omar ; van der Kwast, Theodorus ; Finelli, Antonio ; Zlotta, Alexandre R. ; Hamilton, Robert J. ; Berlin, Alejandro ; Perlis, Nathan ; Fleshner, Neil E. / Salvage radical prostatectomy following focal therapy : functional and oncological outcomes. In: BJU International. 2019.
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title = "Salvage radical prostatectomy following focal therapy: functional and oncological outcomes",
abstract = "Objectives: To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). Patients and Methods: A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. Results: In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9{\%}) patients had iatrogenic cystotomies and four (11.8{\%}) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2{\%}) patients, pT3a in 16 (47.1{\%}), and pT3b in four (11.8{\%}). In all, 13 (38{\%}) patients had positive surgical margins (PSMs). Six (17.6{\%}) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6{\%}) patients developed biochemical recurrence (BCR), and of these, six (17.6{\%}) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95{\%} confidence interval 2.243–19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5–9.5) and 23.5 (15.75–25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5–11) and 6 (5–12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2{\%}) patients were continent, two (5.9{\%}) had moderate (>1 pad/day) incontinence, and one (2.9{\%}) required an artificial urinary sphincter. Conclusions: sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.",
keywords = "#PCSM, #ProstateCancer, focal therapy, high-intensity focussed ultrasound, prostate cancer, recurrence, salvage prostatectomy",
author = "Herrera-Caceres, {Jaime O.} and Nason, {Gregory J.} and Noelia Salgado-Sanmamed and Hanan Goldberg and Woon, {Dixon T.S.} and Thenappen Chandrasekar and Khaled Ajib and Tan, {Guan Hee} and Omar Alhunaidi and {van der Kwast}, Theodorus and Antonio Finelli and Zlotta, {Alexandre R.} and Hamilton, {Robert J.} and Alejandro Berlin and Nathan Perlis and Fleshner, {Neil E.}",
year = "2019",
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TY - JOUR

T1 - Salvage radical prostatectomy following focal therapy

T2 - functional and oncological outcomes

AU - Herrera-Caceres, Jaime O.

AU - Nason, Gregory J.

AU - Salgado-Sanmamed, Noelia

AU - Goldberg, Hanan

AU - Woon, Dixon T.S.

AU - Chandrasekar, Thenappen

AU - Ajib, Khaled

AU - Tan, Guan Hee

AU - Alhunaidi, Omar

AU - van der Kwast, Theodorus

AU - Finelli, Antonio

AU - Zlotta, Alexandre R.

AU - Hamilton, Robert J.

AU - Berlin, Alejandro

AU - Perlis, Nathan

AU - Fleshner, Neil E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). Patients and Methods: A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. Results: In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243–19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5–9.5) and 23.5 (15.75–25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5–11) and 6 (5–12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. Conclusions: sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.

AB - Objectives: To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). Patients and Methods: A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. Results: In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243–19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5–9.5) and 23.5 (15.75–25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5–11) and 6 (5–12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. Conclusions: sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.

KW - #PCSM

KW - #ProstateCancer

KW - focal therapy

KW - high-intensity focussed ultrasound

KW - prostate cancer

KW - recurrence

KW - salvage prostatectomy

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