Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

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

doi:10.1111/bju.14976

Cited by 30 publications

(25 citation statements)

References 30 publications

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“…In their study, 77% of men who had focal ablation required 0 or 1 urinary continence pads at 12 months, similar to that reported in the current study (22/23 [96%]); however, the majority of men in their cohort had undergone whole gland ablation therapy which is likely to have a greater impact on continence recovery. Herrera-Caceres et al also recently reported on their cohort of men undergoing surgery after focal ablation [17]. In their study of 34 men, a similar proportion of men were continent after surgery as that reported in RAFT (31/34 [91%]).…”

Section: Comparison With Other Studiessupporting

confidence: 58%

Outcomes of the RAFT trial: robotic surgery after focal therapy

Cathcart¹,

Ribeiro²,

Moore³

et al. 2021

BJU International

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To report toxicity of treatment observed in men participating in the Robotic surgery After Focal Therapy (RAFT) clinical trial. Patients and MethodsMen were eligible for this prospective single group interventional study if they had histologically confirmed recurrent/ residual prostate adenocarcinoma following primary FT. The short-form Expanded Prostate Cancer Index Composite (EPIC-26) measured prior to salvage robotic prostatectomy (S-RARP) and 3-monthly post-operatively together with Clavien-Dindo complications (I-IV). Secondary outcomes included biochemical recurrence-free survival (BCFS) following surgery and need for salvage treatment after surgery. This study is registered with ClinicalTrials.gov NCT03011606. ResultsTwenty-four men were recruited between February 2016 and September 2018. 1 patient withdrew from the trial after consenting and before S-RARP. 23 men completed 12-month post S-RARP follow-up. Median EPIC-26 urinary continence scores initially deteriorated after 3 months (82.4 vs 100) but there was no statistically significant difference from baseline at 12 months (100 vs 100, P = 0.31). Median lower urinary tract symptom scores improved after 12 months compared to baseline (93.8 vs 87.5, P = 0.01). At 12 months, 19/23 (83%) were pad-free and 22/23 (96%) required 0/1 pads. Median sexual function subscale scores deteriorated and remained low at 12 months (22.2 vs 58.3, P < 0.001). Utilising a minimally important difference of nine points, at 12 months after surgery 17/23 (74%) reported urinary continence to be 'better' or 'not different' to pre-operative baseline. The corresponding figure for sexual function (utilising a minimally important difference of 12 points) was 7/23 (30%). There was no statistically significant difference on median bowel/hormonal subscale scores. Only a single patient had a post-operative complication (Clavien-Dindo Grade I). BCFS at 12 months after surgery was 82.6% (95% confidence interval [CI]: 60.1-93.1%) while 4/23 (17%) received salvage radiation. ConclusionsThe RAFT clinical trial suggests toxicity of surgery after FT is low, with good urinary function outcomes, albeit sexual function deteriorated overall. Oncological outcomes at 12 months appear acceptable.

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Section: Comparison With Other Studiessupporting

confidence: 58%

Outcomes of the RAFT trial: robotic surgery after focal therapy

Cathcart¹,

Ribeiro²,

Moore³

et al. 2021

BJU International

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“…However, more recent work in 2010 showed continence rates of 71% for sRARP [21]. Salvage RARP after focal therapy had better continence outcomes than whole gland therapy with medium-term continence rates varying from 73% to 91% [14,22]. In our study, full continence rates were greater at all time intervals after focal therapy than after whole gland therapy.…”

Section: Functional Outcomescontrasting

confidence: 41%

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

Nathan

Fricker

Groote

et al. 2021

British Journal of Surgery

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Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

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“…Salvage RARP after focal therapy had better continence outcomes than whole gland therapy with medium-term continence rates varying from 73% to 91% [14] , [22] . In our study, full continence rates were greater at all time intervals after focal therapy than after whole gland therapy.…”

Section: Discussionmentioning

confidence: 96%

Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre

Nathan

Fricker

Groote

et al. 2021

European Urology Open Science

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Background Salvage robot-assisted radical prostatectomy (sRARP) is a potential treatment option for locally recurrent prostate cancer (PCa) after nonsurgical primary treatment. There are minimal data comparing outcomes between propensity-matched sRARP and primary robot-assisted radical prostatectomy (RARP). Objective The primary objective is to compare perioperative, oncological, and functional outcomes of sRARP with primary RARP, and the secondary is to compare outcomes between sRARP after whole and focal gland therapy. Design, setting, and participants A 1:1 propensity-matched comparison was carried out of 135 sRARP cases with primary RARP cases from a cohort of 3852 consecutive patients from a high-volume tertiary centre. Outcome measurements and statistical analysis Perioperative, oncological, and functional outcomes including complication rates, positive surgical margins, biochemical recurrence (BCR), continence, and erectile dysfunction (ED) were retrospectively collected. Results and limitations There were no significant differences in patient characteristics between sRARP and primary RARP groups. In the salvage and primary groups, median (interquartile range) follow-up periods were 521 (304–951) and 638 (394–951) d, grade III–V Clavien-Dindo complication rates were 1.5% and 0% ( p = 0.310), BCR rates were 31.9% and 14.1% ( p < 0.001) at the last follow-up, pad-free continence rates were 78.8% and 84.3% at 2 yr ( p = 0.337), and ED rates were 94.8% and 76.3% ( p < 0.001), respectively. Comparing the whole and focal gland groups, BCR rates were 36.7% and 29.1% ( p = 0.687) at follow-up, pad-free continence rates were 53.1% and 89.3% at 2 yr ( p < 0.001), and ED rates were 98% and 93% ( p = 0.214), respectively. Conclusions Salvage RARP has similar perioperative outcomes to primary RARP with inferior potency rates. Post–focal therapy sRARP has similar recurrence and continence rates to primary RARP. Post–whole gland therapy, complication, and recurrence rates are higher, and there is a higher risk of urinary incontinence. Patient summary We report the largest propensity-matched comparison of salvage robot-assisted radical prostatectomy (RARP) after focal and whole gland therapy. Salvage RARP is a feasible procedure for the treatment of locally recurrent prostate cancer in high-volume centres; however, patients should be counselled appropriately as to the different outcomes.

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Salvage radical prostatectomy following focal therapy: functional and oncological outcomes

Cited by 30 publications

References 30 publications

Outcomes of the RAFT trial: robotic surgery after focal therapy

Outcomes of the RAFT trial: robotic surgery after focal therapy

283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre

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