Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre. EUR UROL SUPPL 2021;27:43-52. [PMID: 33997823 PMCID: PMC8090976 DOI: 10.1016/j.euros.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open

For:	Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre. EUR UROL SUPPL 2021;27:43-52. [PMID: 33997823 PMCID: PMC8090976 DOI: 10.1016/j.euros.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open

Number

Cited by Other Article(s)

Thakker PU, Sandberg M, Hemal AK, Rodriguez AR. A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy. Int Braz J Urol 2024;50:398-414. [PMID: 38701186 PMCID: PMC11262726 DOI: 10.1590/s1677-5538.ibju.2024.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open

Abstract

BACKGROUND AND OBJECTIVE

Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP.

MATERIALS AND METHODS

We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively.

CONCLUSIONS

Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.

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Porcaro AB, Bianchi A, Gallina S, Panunzio A, Tafuri A, Serafin E, Orlando R, Mazzucato G, Ornaghi PI, Cianflone F, Montanaro F, Artoni F, Baielli A, Ditonno F, Migliorini F, Brunelli M, Siracusano S, Cerruto MA, Antonelli A. Prognostic Impact and Clinical Implications of Adverse Tumor Grade in Very Favorable Low- and Intermediate-Risk Prostate Cancer Patients Treated with Robot-Assisted Radical Prostatectomy: Experience of a Single Tertiary Referral Center. Cancers (Basel) 2024;16:2137. [PMID: 38893256 PMCID: PMC11171498 DOI: 10.3390/cancers16112137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/25/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open

Affiliation(s)

Antonio Benito Porcaro Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Alberto Bianchi Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Sebastian Gallina Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Andrea Panunzio Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Alessandro Tafuri Department of Urology, Vito Fazzi Hospital, 73110 Lecce, Italy;
Emanuele Serafin Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Rossella Orlando Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Giovanni Mazzucato Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Paola Irene Ornaghi Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Francesco Cianflone Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Francesca Montanaro Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Francesco Artoni Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Alberto Baielli Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Francesco Ditonno Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.) Department of Urology, Rush University Medical Center, Chicago, IL 60612, USA
Filippo Migliorini Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Matteo Brunelli Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy;
Salvatore Siracusano Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
Maria Angela Cerruto Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)
Alessandro Antonelli Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37129 Verona, Italy; (A.B.P.); (A.B.); (S.G.); (A.P.); (E.S.); (R.O.); (G.M.); (P.I.O.); (F.C.); (F.M.); (F.A.); (A.B.); (F.M.); (M.A.C.); (A.A.)

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Rodler S, Danninger D, Eismann L, Kazmierczak PM, Jokisch F, Li M, Becker A, Kretschmer A, Stief C, Westhofen T. Health-related quality of life following salvage radical prostatectomy for recurrent prostate cancer after radiotherapy or focal therapy. World J Urol 2024;42:242. [PMID: 38635030 PMCID: PMC11026200 DOI: 10.1007/s00345-024-04945-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open

Bhat KRS, Nathan A, Moschovas MC, Nathan S, Patel VR. Outcomes of salvage robot-assisted radical prostatectomy in patients who had primary focal versus whole-gland ablation: a multicentric study. J Robot Surg 2023;17:2995-3003. [PMID: 37903973 DOI: 10.1007/s11701-023-01738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023]

Abstract

In the present study, we present comparative outcomes of radical prostatectomy after whole-gland therapy (wg-SRARP) and focal gland therapy (f-SRARP). The study assessed 339 patients who underwent salvage robot-assisted radical prostatectomy (SRARP); 145 patients who had primary focal therapy and 194 patients who had primary whole-gland treatment. SRARP was performed in all cases using a standardized technique developed at respective institutes with the da Vinci Xi Surgical System. Our primary endpoint was the comparison of the functional and oncological outcomes between the groups. Cox proportional hazard was used to study the functional and oncological outcomes. The median total operative time for f-SRARP was 18 min higher than wg-RARP (p < 0.001). Higher rates of nerve-sparing were performed in f-SRARP (focal vs whole gland; bilateral-15.2% vs 9.3%; unilateral 49% vs 28.4%; p < 0.001). wg-SRARP had higher rates of ISUP 5 (26.3% vs 19.3%; p < 0.001) and deferred ISUP score due to altered pathology (14.8% vs 0.7; p < 0.001), while f-SRARP had higher rates of ISUP 4 (11.7% vs 10.7%; p < 0.001) and ≥ pT3a (64.8% vs 51.6%; p < 0.001). Positive margins were significantly higher with f-SRARP (26.2% vs 10.3%; p < 0.001). Functional outcomes were poor in both the groups. However, postoperative continence was higher and faster in patients who had f-SRARP compared to wg-SRARP (69% vs. 54.6%; p = 0.013). We could not identify statistically significant difference in postoperative potency recovery and biochemical recurrence. We present the largest multi-institutional analyses of f-SRARP and wg-SRARP. SRARP is challenging wherein patients have adverse pathological features and increased surgical complexity irrespective of the primary treatment. Focal therapy group had higher rates of nerve-sparing, however, with increased positive surgical margins. Both groups had poor functional outcomes regardless of nerve-sparing degree, indicating significant ipsilateral and contralateral damage to tissues surrounding the prostate during primary treatment. We believe that this analysis is crucial for counseling patients regarding expected outcomes before performing a salvage treatment following ablative therapy failure.

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Saouli A, Ruffion A, Dariane C, Barret E, Fiard G, Hankard GF, Créhange G, Roubaud G, Beauval JB, Brureau L, Renard-Penna R, Gauthé M, Baboudjian M, Ploussard G, Rouprêt M. Salvage Radical Prostatectomy for Recurrent Prostate Cancer: A Systematic Review (French ccAFU). Cancers (Basel) 2023;15:5485. [PMID: 38001745 PMCID: PMC10670522 DOI: 10.3390/cancers15225485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open

Abstract

The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment (n = 3240, 84%). Other first-line treatments included HIFU (n = 338, 9%), electroporation (n = 59, 2%), proton beam therapy (n = 54, 1.5%), cryotherapy (n = 34, 1%), focal vascular targeted photodynamic therapy (n = 22, 0.6%), and transurethral ultrasound ablation (n = 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.

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Affiliation(s)

Amine Saouli Department of Urology, CHU Souss Massa, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir 80000, Morocco
Alain Ruffion Service D’urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69002 Lyon, France; Équipe 2, Centre D’innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, 69002 Lyon, France Comité de Cancérologie de l’Association Française d’Urologie, Groupe Prostate, Maison de l’Urologie, 11, Rue Viète, 75017 Paris, France; (G.F.); (M.G.)
Charles Dariane Department of Urology, Hôpital Européen Georges-Pompidou, AP-HP, Paris University, U1151 Inserm-INEM, F-75015 Paris, France;
Eric Barret Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France; (E.B.); (L.B.)
Gaëlle Fiard Comité de Cancérologie de l’Association Française d’Urologie, Groupe Prostate, Maison de l’Urologie, 11, Rue Viète, 75017 Paris, France; (G.F.); (M.G.) Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38400 Grenoble, France
Gaelle Fromont Hankard Department of Pathology, CHRU Tours, 37000 Tours, France;
Gilles Créhange Department of Radiotherapy, Institut Curie, 75005 Paris, France;
Guilhem Roubaud Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
Jean Baptiste Beauval Department of Urology, CHU Rennes, CIC 1414 Rennes, France;
Laurent Brureau Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France; (E.B.); (L.B.)
Raphaëlle Renard-Penna AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, 75013 Paris, France;
Mathieu Gauthé Comité de Cancérologie de l’Association Française d’Urologie, Groupe Prostate, Maison de l’Urologie, 11, Rue Viète, 75017 Paris, France; (G.F.); (M.G.)
Michael Baboudjian Service D’urologie et de Transplantation Rénale, CHU La Conception, 13005 Marseille, France;
Guillaume Ploussard Department of Urology, La Croix du Sud Hôpital, 31130 Quint-Fonsegrives, France;
Morgan Rouprêt GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013 Paris, France;

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Moschovas MC, Bravi CA, Dell'Oglio P, Turri F, de Groote R, Liakos N, Wenzel M, Würnschimmel C, Di Maida F, Piramide F, Andras I, Breda A, Mottrie A, Patel V, Larcher A. Outcomes of Salvage Robotic-assisted Radical Prostatectomy in the last decade: systematic review and perspectives of referral centers. Int Braz J Urol 2023;49:677-687. [PMID: 37903005 PMCID: PMC10947626 DOI: 10.1590/s1677-5538.ibju.2023.0467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 11/01/2023] Open

Abstract

PURPOSE

Salvage robotic-assisted radical prostatectomy (S-RARP) has gained prominence in recent years for treating patients with cancer recurrence following non-surgical treatments of Prostate Cancer. We conducted a systematic literature review to evaluate the role and outcomes of S-RARP over the past decade.

MATERIAL AND METHODS

A systematic review was conducted, encompassing articles published between January 1st, 2013, and June 1st, 2023, on S-RARP outcomes. Articles were screened according to PRISMA guidelines, resulting in 33 selected studies. Data were extracted, including patient demographics, operative times, complications, functional outcomes, and oncological outcomes.

RESULTS

Among 1,630 patients from 33 studies, radiotherapy was the most common primary treatment (42%). Operative times ranged from 110 to 303 minutes, with estimated blood loss between 50 to 745 mL. Intraoperative complications occurred in 0 to 9% of cases, while postoperative complications ranged from 0 to 90% (Clavien 1-5). Continence rates varied (from 0 to 100%), and potency rates ranged from 0 to 66.7%. Positive surgical margins were reported up to 65.6%, and biochemical recurrence ranged from 0 to 57%.

CONCLUSION

Salvage robotic-assisted radical prostatectomy in patients with cancer recurrence after previous prostate cancer treatment is safe and feasible. The literature is based on retrospective studies with inherent limitations describing low rates of intraoperative complications and small blood loss. However, potency and continence rates are largely reduced compared to the primary RARP series, despite the type of the primary treatment. Better-designed studies to assess the long-term outcomes and individually specify each primary therapy impact on the salvage treatment are still needed. Future articles should be more specific and provide more details regarding the previous therapies and S-RARP surgical techniques.

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Affiliation(s)

Marcio Covas Moschovas AdventHealth Global Robotics InstituteFloridaUSAAdventHealth Global Robotics Institute, Florida, USA University of Central FloridaFloridaUSAUniversity of Central Florida (UCF), Florida, USA ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
Carlo Andrea Bravi The Royal Marsden NHS Foundation TrustDepartment of UrologyLondonUKDepartment of Urology, The Royal Marsden NHS Foundation Trust, London, UK
Paolo Dell'Oglio ASST Grande Ospedale Metropolitano NiguardaMilanItalyASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
Filippo Turri La Statale UniversityASST Santi Paolo e CarloMilanItalyASST Santi Paolo e Carlo - La Statale University, Milan, Italy
Ruben de Groote ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium OLV HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, OLV Hospital, Aalst, Belgium
Nikolaos Liakos University of Freiburg Medical CentreGermanyUniversity of Freiburg Medical Centre, Germany
Mike Wenzel University Hospital FrankfurtGermanyUniversity Hospital Frankfurt, Germany;
Christoph Würnschimmel Luzerner KantonsspitalSwitzerlandLuzerner Kantonsspital, Switzerland;
Fabrizio Di Maida University of FlorenceFlorenceItalyUniversity of Florence, Florence, Italy;
Federico Piramide University of TurinSan Luigi Gonzaga HospitalItalyUniversity of Turin, San Luigi Gonzaga Hospital, Italy
Iulia Andras Iuliu Hatieganu University of Medicine and PharmacyCluj-NapocaRomaniaIuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania;
Alberto Breda Autonoma University of Barcelona at Fundacio PuigvertBarcelonaSpainAutonoma University of Barcelona at Fundacio Puigvert, Barcelona, Spain;
Alexandre Mottrie ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium OLV HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, OLV Hospital, Aalst, Belgium
Vipul Patel AdventHealth Global Robotics InstituteFloridaUSAAdventHealth Global Robotics Institute, Florida, USA University of Central FloridaFloridaUSAUniversity of Central Florida (UCF), Florida, USA
Alessandro Larcher San Raffaele HospitalMilanItalySan Raffaele Hospital, Milan, Italy

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Deivasigamani S, Orabi H, El-Shafei A, Adams ES, Kotamarti S, Aminsharifi A, Davis L, Wu Y, J SJ, Polascik TJ. Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis. Prostate 2023;83:1373-1386. [PMID: 37469120 DOI: 10.1002/pros.24600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]

Abstract

BACKGROUND

Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT).

METHODS

An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW.

RESULTS

A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different.

CONCLUSION

CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.

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Marra G, Marquis A, Yanagisawa T, Shariat SF, Touijer K, Gontero P. Salvage Radical Prostatectomy for Recurrent Prostate Cancer After Primary Nonsurgical Treatment: An Updated Systematic Review. Eur Urol Focus 2023;9:251-257. [PMID: 36822924 DOI: 10.1016/j.euf.2023.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/03/2023] [Accepted: 01/17/2023] [Indexed: 02/24/2023]

Rocco B, Giorgia G, Simone A, Tommaso C, Mattia S, Stefano T, Ahmed E, Giorgio B, De Concilio B, Celia A, Salvatore M, Sighinolfi MC. Rectal Perforation During Pelvic Surgery. EUR UROL SUPPL 2022;44:54-59. [PMID: 36093319 PMCID: PMC9449548 DOI: 10.1016/j.euros.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open

Sargos P, Supiot S, Créhange G, Fromont-Hankard G, Barret E, Beauval JB, Brureau L, Dariane C, Fiard G, Gauthé M, Mathieu R, Roubaud G, Ruffion A, Renard-Penna R, Neuzillet Y, Rouprêt M, Ploussard G. Oncologic Impact and Safety of Pre-Operative Radiotherapy in Localized Prostate and Bladder Cancer: A Comprehensive Review from the Cancerology Committee of the Association Française d'Urologie. Cancers (Basel) 2021;13:cancers13236070. [PMID: 34885179 PMCID: PMC8656987 DOI: 10.3390/cancers13236070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/23/2022] Open

Abstract

Simple Summary

Radiotherapy may have an interesting role of reinforcing the loco-regional control of cancer, in addition to surgery, when used as a preoperative treatment. This sequence has demonstrated its efficacy and safety in various malignancies, but no strong data exist in the era of uro-oncology. In this review article, we aim to highlight the potential usefulness of preoperative radiotherapy in prostate and muscle-invasive bladder cancer, aiming to enhance pathological response and local control and to prevent intraoperative tumor seeding. We also emphasize the need for further clinical studies assessing the functional safety of subsequent surgical procedures in a competitive context of new systemic agents that have proven to demonstrate a survival benefit in locally advanced urologic cancers.

Abstract

Preoperative radiotherapy (RT) is commonly used for the treatment of various malignancies, including sarcomas, rectal, and gynaecological cancers, but it is preferentially used as a competitive treatment to radical surgery in uro-oncology or as a salvage procedure in cases of local recurrence. Nevertheless, preoperative RT represents an attractive strategy to prevent from intraoperative tumor seeding in the operative field, to sterilize microscopic extension outside the organ, and to enhance the pathological and/or imaging tumor response rate. Several clinical works support this research field in uro-oncology. In this review article, we summarized the oncologic impact and safety of preoperative RT in localized prostate and muscle-invasive bladder cancer. Preliminary studies suggest that both modalities can be complementary as initial primary tumor treatments and that a pre-operative radiotherapy strategy could be beneficial in a well-defined population of patients who are at a very high-risk of local relapse. Future prospective trials are warranted to evaluate the oncologic benefit of such a combination of local treatments in addition to new life-prolonging systemic therapies, such as immunotherapy, and new generation hormone therapies. Moreover, the safety and the feasibility of salvage surgical procedures due to non-response or local recurrence after pelvic RT remain poorly evaluated in that context.

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Affiliation(s)

Paul Sargos Department of Radiotherapy, Institut Bergonié, 33000 Bordeaux, France;
Stéphane Supiot Department of Radiotherapy, Insitut de Cancérologie de l’Ouest, 44800 St-Herblain, France;
Gilles Créhange Department of Radiotherapy, Institut Curie, 75005 Paris, France;
Gaëlle Fromont-Hankard Department of Pathology, CHRU Tours, 37000 Tours, France;
Eric Barret Department of Urology, Institut Mutualiste Montsouris, 75014 Paris, France;
Jean-Baptiste Beauval Department of Urology, La Croix du Sud Hôpital, 31130 Quint Fonsegrives, France;
Laurent Brureau Department of Urology, CHU de Pointe-à-Pitre, University of Antilles, University of Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)—UMR_S 1085, 97110 Pointe-à-Pitre, France;
Charles Dariane Department of Urology, Hôpital Européen Georges-Pompidou, APHP, Paris—Paris University—U1151 Inserm-INEM, Necker, 75015 Paris, France;
Gaëlle Fiard Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000 Grenoble, France;
Mathieu Gauthé Unité de Recherche Clinique en Économie de la Santé, CRESS METHODS INSERM UMR 1153, 75000 Paris, France;
Romain Mathieu Department of Urology, CHU Rennes, 35033 Rennes, France;
Guilhem Roubaud Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
Alain Ruffion Service d’Urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69002 Lyon, France; Equipe 2, Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, 69002 Lyon, France
Raphaële Renard-Penna Department of Radiology, Sorbonne University, AP-HP, Pitie-Salpetriere Hospital, 75013 Paris, France;
Yann Neuzillet Department of Urology, Hôpital Foch, 92151 Suresnes, France;
Morgan Rouprêt Department of Urology, Sorbonne University, GRC 5 Predictive Onco-Uro, AP-HP, Pitie-Salpetriere Hospital, 75013 Paris, France;
Guillaume Ploussard Department of Urology, La Croix du Sud Hôpital, 31130 Quint Fonsegrives, France; Correspondence: ; Tel.: +33-5-32027202; Fax: +33-5-32027203

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Nathan A, Ng A, Mitra A, Sooriakumaran P, Davda R, Patel S, Fricker M, Kelly J, Shaw G, Rajan P, Sridhar A, Nathan S, Payne H. Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer. Clin Oncol (R Coll Radiol) 2021;34:e69-e78. [PMID: 34740477 DOI: 10.1016/j.clon.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022]

Abstract

AIMS

Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT).

MATERIALS AND METHODS

Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre.

RESULTS

High-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively.

CONCLUSION

We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.

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