Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review. World J Urol 2019 Aug;37(8):1517-1534
Date
02/03/2019Pubmed ID
30710157DOI
10.1007/s00345-019-02642-9Scopus ID
2-s2.0-85061008930 (requires institutional sign-in at Scopus site) 21 CitationsAbstract
BACKGROUND: Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown.
OBJECTIVES: To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT.
MATERIALS AND METHODS: A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an 'a priori protocol'. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT.
RESULTS: Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7-62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6-38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed.
CONCLUSIONS: Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.
Author List
Marra G, Gontero P, Walz JC, Sivaraman A, Tourinho-Barbosa R, Cathelineau X, Sanchez-Salas RAuthor
Arjun Sivaraman MD Associate Professor in the Urologic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Decision TreesHumans
Male
Prostatic Neoplasms
Salvage Therapy
Treatment Outcome
