Oncological outcomes of salvage radical prostatectomy for recurrent prostate cancer in the contemporary era: A multicenter study

Marra, Giancarlo; Gontero, Paolo; Calleris, Giorgio; Oderda, Marco; Filippini, Chiara; Sánchez-Salas, Rafael; Goonewardene, Sanchia S.; Popert, R.; Cahill, Declan; Persad, Rajendra; Palou, Joan; Joniau, S.; Taille, A. De La; Rouprêt, Morgan; Albisinni, Simone; Morlacco, Alessandro; Gandaglia, Giorgio; Mottrie, Alexandre; Smith, Jenny; Gill, Inderbir S.; Poel, H. Van Der; Tilki, Derya; Murphy, Declan; Davis, John W.; Karnes, R.J.

doi:10.1016/s2666-1683(20)33404-2

Cited by 4 publications

(4 citation statements)

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“…The majority of PSM were in men with pT3 or greater disease, with pT2 PSM incidence of 22.5% and 18.8% in SRS-RARP and SS-RARP, respectively. Prior SS-RARP series have reported PSM incidence ranging from 28% to 39%, 12,14,23,27 which is comparable to open SRP PSM incidence of 25% reported by Chade et al 13 Our higher PSM rate may be due to large numbers of nerve-sparing procedures within our cohort, with 45.8% of men among both groups undergoing at least partial nerve-sparing. Others have shown the inaccuracy of magnetic resonance imaging to predict T-stage in the salvage setting, and thus, nerve-sparing should be avoided in most salvage prostatectomy cases.…”

Section: Discussionsupporting

confidence: 75%

Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series

Kowalczyk

Madi

Eden³

et al. 2021

Journal of Urology

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Purpose:Salvage radical prostatectomy is rare due to the risk of postoperative complications. We compare salvage Retzius-sparing robotic assisted radical prostatectomy (SRS-RARP) with salvage standard robotic assisted radical prostatectomy (SS-RARP).Materials and Methods:A total of 72 patients across 9 centers were identified (40 SRS-RARP vs 32 SS-RARP). Demographics, perioperative data, and pathological and functional outcomes were compared using Student’s t-test and ANOVA. Cox proportional hazard models and Kaplan-Meier curves were constructed to assess risk of incontinence and time to continence. Linear regression models were constructed to investigate postoperative pad use and console time.Results:Median followup was 23 vs 36 months for SRS-RARP vs SS-RARP. Console time and estimated blood loss favored SRS-RARP. There were no differences in complication rates or oncologic outcomes. SRS-RARP had improved continence (78.4% vs 43.8%, p <0.001 for 0–1 pad, 54.1% vs 6.3%, p <0.001 for 0 pad), lower pads per day (0.57 vs 2.03, p <0.001), and earlier return to continence (median 47 vs 180 days, p=0.008). SRS-RARP was associated with decreased incontinence defined as >0–1 pad (HR 0.28, 95% CI 0.10–0.79, p=0.016), although not when defined as >0 pad (HR 0.56, 95% CI 0.31–1.01, p=0.053). On adjusted analysis SRS-RARP was associated with decreased pads per day. Lymph node dissection and primary treatment with stereotactic body radiation therapy were associated with longer console time.Conclusions:SRS-RARP is a feasible salvage option with significantly improved urinary function outcomes. This may warrant increased utilization of SRS-RARP to manage men who fail nonsurgical primary treatment for prostate cancer.

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Section: Discussionsupporting

confidence: 75%

Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series

Kowalczyk

Madi

Eden³

et al. 2021

Journal of Urology

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“…Furthermore, as shown by Marra et al, recurrences are frequently high grade, with 27% having a GS ≥9 compared to 90% having a GS of ≤7 at initial PC diagnosis. This discrepancy is likely largely related to treatment induced changes and selection of resistant clones, altering the natural history of PC towards adverse features [42]. Nevertheless, potential risks and side effects and patient selection are still a matter of debate for SRP.…”

Section: Discussionmentioning

confidence: 99%

Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic, Histopathologic and Functional Outcomes and Predictors of Good Response

et al. 2021

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A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5–52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended.

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“…Ten-year BCR-free and CSS were 34 and 70%, respectively. Since 2000, more than a few dozen institutional and four large multiinstitutional series have reported their outcomes [11–17,18 ▪▪ ,19]. In majority of these series, about half of the patients had nonorgan-confined disease and about one in three patients had seminal vesicle invasion.…”

Section: Oncologic Outcomesmentioning

confidence: 99%

Salvage radical prostatectomy

Nabavizadeh

Karnes

2022

Current Opinion in Urology

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Purpose of reviewSalvage radical prostatectomy (sRP) is underutilized because of fear of historical high rates of perioperative morbidities. However, there has been significant improvements in complication rates as well as oncologic outcomes in the recent years. Recent findingsComplication rates have significantly declined for both open and robotic approach in the past decade. Rectal injury is now reported around 2%, which is down from 30% in the historic series. Similarly, the current risk of major vascular injury is low. About 75% of patients report social continence (up to one pad per day). However, erectile function recovery remains poor and patients should be counselled accordingly. Long-term durable oncologic response is achievable with 10-year recurrence-free survival reported in about 40--50% of well selected patients. SummaryRecent improvements in oncologic and peri-operative outcomes make sRP a desirable option for local control. sRP treats the whole gland as opposed to focal therapies and allows for pelvic lymph node dissection and removal of seminal vesicles, which can be sanctuary site of disease. In experienced hands, regardless of the surgical approach, sRP can achieve a durable response resulting in delaying or avoiding androgen deprivation therapy and its associated morbidities.

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Oncological outcomes of salvage radical prostatectomy for recurrent prostate cancer in the contemporary era: A multicenter study

Cited by 4 publications

References 0 publications

Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series

Comparative Outcomes of Salvage Retzius-Sparing versus Standard Robotic Prostatectomy: An International, Multi-Surgeon Series

Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic, Histopathologic and Functional Outcomes and Predictors of Good Response

Salvage radical prostatectomy

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