Oncological outcomes of salvage radical prostatectomy for recurrent prostate cancer in the contemporary era: A multicenter retrospective study |
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| Authors: | Giancarlo Marra Robert Jeffrey Karnes Giorgio Calleris Marco Oderda Paolo Alessio Anna Palazzetti Antonino Battaglia Francesca Pisano Stefania Munegato Fernando Munoz Claudia Filippini Umberto Ricardi Estefania Linares Rafael Sanchez-Salas Sanchia Goonewardene Prokar Dasgupta Ben Challacombe Rick Popert Paolo Gontero |
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| Affiliation: | 1. Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy;2. Department of Urology, Institut Mutualiste Montsouris, Paris, France;3. Department of Urology, Mayo Clinic, Rochester, MN;4. Department of Urology, Leuven University Hospitals, Leuven, Belgium;5. Department of Urology, Fundaciò Puigvert, Barcelona, Spain;6. Department of Radiotherapy, Pasini Hospital, Aosta, Italy;7. Department of Statistics, University of Turin, Turin, Italy;8. Department of Radiotherapy and School of Medicine Chair, University of Turin, Turin, Italy;9. Department of Urology, Urology Centre, Guy''s Hospital, London, UK;10. Department of Urology, Royal Marsden Hospital, London, UK;11. Department of Urology, Bristol NHS Foundation Trust, Bristol, UK;12. Department of Urology, Clinique Saint Augustin, Bordeaux, France;13. Department of Urology, CHU Mondor, Créteil, France;14. Department of Urology, Pitié Salpétrière Hospital University Paris 6, Paris, France;15. Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Bruxelles, Belgium;p. Department of Urology, OLV Hospital, Aalst, Belgium;q. Department of Urology, Vanderbilt University, Medical Center North, Nashville, TN, USA;r. Department of Urology, USC Norris Comprehensive Cancer Center and Hospital, University of Southern California, CA;s. Department of Urology, Netherlands Cancer Institute, Amsterdam, Netherlands;t. Department of Urology, Martini Klinik, Hamburg, Germany;u. Department of Urology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia;v. Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX |
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| Abstract: | BackgroundSalvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP show improved results.Our objectives were to evaluate sRP oncological outcomes and predictors of positive margins and biochemical recurrence (BCR).MethodsWe retrospectively collected data of sRP for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers in United States, Australia and Europe, from 2000 to 2016. SM and BCR were evaluated in a univariate and multivariable analysis. Overall and cancer-specific survival were also assessed.ResultsWe included 414 cases, 63.5% of them performed after radiotherapy. Before sRP the majority of patients had biopsy Gleason score (GS) ≤7 (55.5%) and imaging negative or with prostatic bed involvement only (93.3%). Final pathology showed aggressive histology in 39.7% (GS ≥9 27.6%), with 52.9% having ≥pT3 disease and 16% pN+. SM was positive in 29.7%. Five years BCR-Free, cancer-specific survival and OS were 56.7%, 97.7% and 92.1%, respectively. On multivariable analysis pathological T (pT3a odds ratio [OR] 2.939, 95% confidence interval [CI] 1.469–5.879; ≥pT3b OR 2.428–95% CI 1.333–4.423) and N stage (pN1 OR 2.871, 95% CI 1.503–5.897) were independent predictors of positive margins. Pathological T stage ≥T3b (OR 2.348 95% CI 1.338–4.117) and GS (up to OR 7.183, 95% CI 1.906–27.068 for GS >8) were independent predictors for BCR. Limitations include the retrospective nature of the study and limited follow-up.ConclusionsIn a contemporary series, sRP showed promising oncological control in the medium term despite aggressive pathological features. BCR risk increased in case of locally advanced disease and higher GS. Future studies are needed to confirm our findings. |
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