Faculty Collaboration Database

Minimally Invasive Salvage Prostatectomy After Primary Radiation or Ablation Treatment. Urology 2016 Aug;94:111-6

Date

05/08/2016

Pubmed ID

27154045

DOI

10.1016/j.urology.2016.04.040

Scopus ID

2-s2.0-84971618258 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

OBJECTIVE: To analyze oncologic, functional and morbidity outcomes for patients undergoing minimally invasive salvage prostatectomy (MISP) at our institution.

PATIENTS AND METHODS: Between 2001 and 2015, 5841 patients underwent radical prostatectomy at our institution, out of which 28 were MISP. Indications for MISP were prostate-specific antigen nadir +2 ng/dL in radio-recurrent patients and biopsy-proven prostate cancer (PCa) in other ablative treatments. We analyzed primary cancer characteristics, surgical data, perioperative complications, oncologic and functional outcomes of MISP, and further compared results between MISP after primary whole-gland treatment (WT) and focal treatment (FT).

RESULTS: Median age at salvage treatment was 65 (interquartile range [IQR] 61-68). Compared with WT, MISP after FT had significantly lower operative time (133 vs 176 min, P = .001) and fewer upstaging (≥pT3a) (28% vs 79%, P = .008) at final pathology. Overall, positive surgical margin (PSM) were noted in 4 patients (14%). Perioperative complications were observed in 9 patients with no difference between groups. At 12-months follow-up, 57% were continent and 33% had moderate to severe urinary leak. Potency was preserved in 6 out of 10 preoperatively potent patients. Over a median follow-up of 62 months (IQR 43-110), 11 patients relapsed with a median time to biochemical recurrence of 16 months (IQR 7-25). Recurrences were managed with salvage radiotherapy in 6 patients, 4 with hormone therapy and 1 castration-resistant prostate cancer. Overall, 24 patients are alive at last follow-up and 18 (72%) remain disease free.

CONCLUSION: MISP after primary radiation or ablation for prostate cancer is feasible and safe with acceptable oncological outcomes. Compared with FT, MISP after WT appears to have longer operative time and more frequent upstaging.

Author List

Linares Espinós E, Sánchez-Salas R, Sivaraman A, Perez-Reggeti JI, Barret E, Rozet F, Galiano M, Prapotnich D, Cathelineau X

Author

Arjun Sivaraman MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Ablation Techniques
Aged
Combined Modality Therapy
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
Prostatectomy
Prostatic Neoplasms
Retrospective Studies
Salvage Therapy
Treatment Outcome