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Blank F, Meyer M, Wang H, Abbas H, Tayebi S, Hsu WW, Sidana A. Salvage Radical Prostatectomy after Primary Focal Ablative Therapy: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:2727. [PMID: 37345064 DOI: 10.3390/cancers15102727] [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: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
CONTEXT Focal therapy (FT) has been gaining popularity as a treatment option for localized intermediate-risk prostate cancer (PCa) due to the associated lower morbidity compared to whole-gland treatment. However, there is an increased risk of local cancer recurrence requiring subsequent treatment in a small proportion of patients. OBJECTIVE To conduct a systematic review and meta-analysis to better describe and analyze patient postoperative, oncologic, and functional outcomes for those who underwent salvage radical prostatectomy (sRP) to manage their primary FT failure. EVIDENCE ACQUISITION A systematic review was completed using three databases (PubMed, Embase, and CINAHL) from October to December 2021 to identify data on outcomes in patients who received sRP for cancer recurrence after prior focal treatment. EVIDENCE SYNTHESIS 12 articles (482 patients) were included. Median time to sRP was 24 months. Median follow-up time was 27 months. A meta-analysis revealed a postoperative complication rate of 15% (95% CI: 0.09, 0.24), with 4.6% meeting criteria for a major complication Clavien (CG) grade ≥3. Severe GU toxicity was seen in 3.6% of the patients, and no patients had severe GI toxicity. Positive surgical margins (PSM) were found in 27% (95% CI: 0.19, 0.37). Biochemical recurrence (BCR) after sRP occurred in 23% (95% CI: 0.17, 0.30), indicating a BCR-free probability of 77% at 2 years. Continence (pad-free) and potency (ability to have penetrative sex) were maintained in 67% (95% CI: 0.53, 0.78) and 37% (95% CI: 0.18, 0.62) at 12 months, respectively. CONCLUSION Our evidence shows acceptable complication rates and oncologic outcomes; however, with suboptimal functional outcomes for patients undergoing sRP for recurrent PCa after prior FT. Inferior outcomes were observed for salvage treatment compared to primary radical prostatectomy (pRP). More high-quality studies are needed to better characterize outcomes after this sequence of PCa treatments. PATIENT SUMMARY We looked at treatment outcomes and toxicity for men treated with sRP for prior FT failure. We conclude that these patients will have significant detriment to genitourinary function, with outcomes being worse than those for pRP patients.
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Affiliation(s)
- Fernando Blank
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Meredith Meyer
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Hannah Wang
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Hasan Abbas
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Shima Tayebi
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Wei-Wen Hsu
- Division of Biostatistics and Bioinformatics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Geboers B, Gondoputro W, Thompson JE, Reesink DJ, van Riel LAMJG, Zhang D, Blazevski A, Doan P, Agrawal S, Matthews J, Haynes AM, Liu Z, Delprado W, Shnier R, de Reijke TM, Lawrentschuk N, Stijns PEF, Yaxley JW, Scheltema MJ, Stricker PD. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Detect Residual Prostate Cancer Following Irreversible Electroporation-A Multicenter Validation Study. Eur Urol Focus 2022; 8:1591-1598. [PMID: 35577751 DOI: 10.1016/j.euf.2022.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/15/2022] [Accepted: 04/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Accurate monitoring following focal treatment of prostate cancer (PCa) is paramount for timely salvage treatment or retreatment. OBJECTIVE To evaluate the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) to detect residual PCa in the short-term follow-up of focal treatment with irreversible electroporation (IRE) using transperineal or transrectal template ± targeted biopsies. DESIGN, SETTING, AND PARTICIPANTS A retrospective international multicenter study of men with biopsy-proven PCa, treated with focal IRE, and followed by mpMRI (index-test) and template biopsies (reference-test) between February 2013 and January 2021, was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI were calculated for in- and outfield residual disease based on two definitions of significant PCa: University College London (UCL) 1-International Society of Urological Pathology (ISUP) ≥3 or ISUP ≥1 with maximum cancer core length (MCCL) ≥6 mm, and UCL2-ISUP ≥2 or ISUP ≥1 with MCCL ≥4 mm. RESULTS AND LIMITATIONS A total of 303 patients from five focal therapy centers were treated with primary IRE. The final analysis was performed on 217 men (median age 67, median prostate-specific antigen 6.2, 81% ISUP 2/3) who underwent both mpMRI and template biopsies. Multiparametric MRI missed 38/57 (67%) positive biopsy locations (UCL1) in 22 patients. Sensitivity, specificity, PPV, and NPV of mpMRI to detect whole gland residual disease (UCL1) were 43.6% (95% confidence interval [CI]: 28-59), 80.9% (95% CI: 75-86), 33.3% (95% CI: 21-47), and 86.7% (95% CI: 81-91), respectively. Based on UCL2, sensitivity, specificity, PPV, and NPV were 35.8% (95% CI: 25-48), 82.0% (95% CI: 75-88), 47.1% (95% CI: 34-61), and 74.1% (95% CI: 67-80), respectively. Limitations are the retrospective nature and short follow-up. CONCLUSIONS The diagnostic accuracy of mpMRI to detect residual clinically significant PCa following IRE was low. Follow-up template biopsies should be performed, regardless of mpMRI results. PATIENT SUMMARY We investigated the accuracy of magnetic resonance imaging (MRI) to detect residual prostate cancer after treatment with irreversible electroporation. The accuracy of MRI is insufficient, and we emphasize the importance of confirmatory prostate biopsies.
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Affiliation(s)
- Bart Geboers
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia; Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers (location VUmc), Free University, Amsterdam, The Netherlands.
| | - William Gondoputro
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - James E Thompson
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Daan J Reesink
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Luigi A M J G van Riel
- Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands
| | - David Zhang
- Department of Urology, E.J. Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
| | - Alexandar Blazevski
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Paul Doan
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Jayne Matthews
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia
| | - Zhixin Liu
- Department of Biostatistics, University of New South Wales, NSW, Australia
| | | | | | - Theo M de Reijke
- Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Nathan Lawrentschuk
- Department of Urology, E.J. Whitten Prostate Cancer Research Centre at Epworth, Melbourne, VIC, Australia
| | - Pascal E F Stijns
- Department of Urology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - John W Yaxley
- Department of Urology, The Wesley Hospital, Brisbane, QLD, Australia
| | - Matthijs J Scheltema
- Garvan Institute of Medical Research and The Kinghorn Cancer Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia; Department of Urology, Amsterdam University Medical Centers (location AMC), University of Amsterdam, Amsterdam, The Netherlands; Prostate Cancer Network The Netherlands, Amsterdam, The Netherlands
| | - Phillip D Stricker
- Department of Urology, St. Vincent's Prostate Cancer Research Centre, Darlinghurst, Sydney, NSW, Australia
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Kotamarti S, Séguier D, Arcot R, Polascik TJ. Assessment after focal therapy: what is the latest? Curr Opin Urol 2022; 32:260-266. [PMID: 35275100 DOI: 10.1097/mou.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review assessment after focal therapy (FT) in the context of developments from the past two years. RECENT FINDINGS With a paucity of high-quality studies, recent findings are primarily reliant on results from institutional-based cohorts and reports of expert consensus. Notably, oncologic treatment failure should be further stratified into recurrence in the in-field or out-of-field ablation zone, and both regions should be surveilled postoperatively. Monitoring primarily consists of periodic evaluations of prostate-specific antigen (PSA) testing and magnetic resonance imaging, with histologic sampling needed to confirm suspicion of recurrence. Recent investigations into PSA derivatives, contrast-enhanced ultrasound, and prostate-specific membrane antigen imaging have shown preliminary promise. Although postablation functional outcomes are generally accepted to be excellent, they are limited by the wide range of patient-reported measures, variability in individual practice, and low questionnaire completion rates. SUMMARY There is still a need for high-level, long-term data to inform exact standardized protocols to manage patients after FT. A multifaceted approach is required to surveil patients and identify those at risk of recurrence. Embracing shared responsibility between the patient and clinician to fastidiously monitor the infield and out-of-field ablation zones postoperatively is critical to maximize oncologic outcomes.
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Affiliation(s)
- Srinath Kotamarti
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Denis Séguier
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
- Department of Urology, Lille University, Lille, France
| | - Rohith Arcot
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Thomas J Polascik
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
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Candela L, Kasraeian A, Barret E. Current evidence for focal laser ablation and vascular-targeted photodynamic therapy for localized prostate cancer: review of literature published in the last 2 years. Curr Opin Urol 2022; 32:192-198. [PMID: 35013079 DOI: 10.1097/mou.0000000000000964] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Currently, a significant number of patients are diagnosed with unilateral and apparently unifocal low or intermediate-risk prostate cancer (PCa). These patients are suitable for focal therapy, thus preventing radical treatment side effects without affecting cancer control. Among focal therapy energy sources, laser-based technologies have shown promising outcomes. We aimed to summarize recent data on focal laser ablation (FLA) and vascular-targeted photodynamic therapy (VTP) for PCa. RECENT FINDINGS We selected eight studies reporting data on 1155 patients with PCa who underwent laser-based focal therapy. Five studies were on FLA and three on VTP (six prospective and two retrospective series); four reported both oncologic and functional outcomes whereas in three only oncologic and one only functional outcomes were discussed. Follow-up protocols and durations varied widely among the studies. PCa recurrence rates ranged between 20 and 56%. Urinary and erectile function were preserved after treatment, and complications were mild and transient. A lack of high-quality data on long-term oncological outcomes still remains, thus further highlighting the need for prospective controlled studies. SUMMARY FLA and VTP are well tolerated procedures with excellent functional outcomes. However, both procedures showed a significant rate of PCa recurrence, thus demonstrating a certain grade of oncologic control failure of the procedure and/or nonoptimal patients' selection.
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Affiliation(s)
- Luigi Candela
- Urology Department, Institut Mutualiste Montsouris, Paris, France
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Eric Barret
- Urology Department, Institut Mutualiste Montsouris, Paris, France
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Yaxley WJ, Gianduzzo T, Kua B, Oxford R, Yaxley JW. Focal therapy for prostate cancer with irreversible electroporation: Oncological and functional results of a single institution study. Investig Clin Urol 2022; 63:285-293. [PMID: 35534217 PMCID: PMC9091832 DOI: 10.4111/icu.20210472] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/01/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Materials and Methods Results Conclusions
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Affiliation(s)
- William John Yaxley
- Department of Urology, QEII Jubilee Hospital, Brisbane, Australia
- The University of Queensland, School of Medicine, Brisbane, Australia
| | - Troy Gianduzzo
- The University of Queensland, School of Medicine, Brisbane, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - Boon Kua
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - Rachel Oxford
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
| | - John William Yaxley
- The University of Queensland, School of Medicine, Brisbane, Australia
- Wesley Urology Clinic, Wesley Hospital, Brisbane, Australia
- Department of Urology, Royal Brisbane and Women’s Hospital, Brisbane, Australia
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