Salvage Radiotherapy Following Partial Gland Ablation for Prostate Cancer: Functional and Oncological Outcomes

Qaoud, Yazan; Bettoli, Piero; Sanmamed-Salgado, Noelia; Herrera-Cáceres, Jaime O.; Berjaoui, Mohamad Baker; Lajkosz, Katherine; Goldberg, Hanan; Woon, Dixon T.S.; Glase, Zoe; Ghai, Sangeet; Finelli, Antonio; Chung, Peter; Perlis, Nathan; Fleshner, Neil; Berlín, Alejandro

doi:10.1016/j.euros.2020.07.002

Cited by 1 publication

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“…Our data from S-RP specimen show that the final ISUP is hardly predictable from combined systematic and targeted biopsy, which questions this approach. The efficacy of S-RT after FT has been described in 21 patients in one report so far [7]. The median time until detection of cancer relapse after FT was longer (32 months) and PSA levels lower (4.6 ng/ml).…”

Section: Discussionmentioning

confidence: 98%

“…Salvage radical prostatectomy (S-RP) has been reported as feasible but could lead to inferior oncological outcomes compared to primary radical prostatectomy [6]. Salvage-radiotherapy (S-RT) has only been described in one report [7]. Active surveillance (AS) and comparative reports in this setting have not been described hampering decision-making and exposing patients potentially to overtreatment and undertreatment.…”

Section: Introductionmentioning

confidence: 99%

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Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer

et al. 2021

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Purpose Due to the tissue preserving approach of focal therapy (FT), local cancer relapse can occur. Uncertainty exists regarding triggers and outcome of salvage strategies. Methods Patients with biopsy-proven prostate cancer (PCa) after FT for localized PCa from 2011 to 2020 at eight tertiary referral hospitals in Germany that underwent salvage radical prostatectomy (S-RP), salvage radiotherapy (S-RT) or active surveillance (AS) were reported. Prostate specific antigen (PSA) changes, suspicious lesions on mpMRI and histopathological findings on biopsy were analyzed. A multivariable regression model was created for adverse pathological findings (APF) at S-RP specimen. Kaplan–Meier curves were generated to determine oncological outcomes. Results A total of 90 men were included. Cancer relapse after FT was detected at a median of 12 months (IQR 9–16). Of 50 men initially under AS 13 received S-RP or S-RT. In total, 44 men underwent S-RP and 13 S-RT. At cancer relapse 17 men (38.6%) in the S-RP group [S-RT n = 4 (30.8%); AS n = 3 (6%)] had ISUP > 2. APF (pT ≥ 3, ISUP ≥ 3, pN + or R1) were observed in 23 men (52.3%). A higher ISUP on biopsy was associated with APF [p = 0.006 (HR 2.32, 97.5% CI 1.35–4.59)] on univariable analysis. Progression-free survival was 80.4% after S-RP and 100% after S-RT at 3 years. Secondary therapy-free survival was 41.7% at 3 years in men undergoing AS. Metastasis-free survival was 80% at 5 years for the whole cohort. Conclusion With early detection of cancer relapse after FT S-RP and S-RT provide sufficient oncologic control at short to intermediate follow-up. After AS, a high secondary-therapy rate was observed.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%