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Lama DJ, Thomas K, Ferenczi B, Okunowo O, Lau CS, Yuh BE. Long-term Outcomes and Patient Satisfaction Following Salvage Robot-assisted Radical Prostatectomy: A Modern Perspective. EUR UROL SUPPL 2024; 60:1-7. [PMID: 38375345 PMCID: PMC10874866 DOI: 10.1016/j.euros.2023.11.011] [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: 11/29/2023] [Indexed: 02/21/2024] Open
Abstract
Background and objective Approximately two-thirds of men who undergo primary treatment for prostate cancer (PC) will experience biochemical recurrence (BCR). Salvage robot-assisted radical prostatectomy (sRARP) offers curative treatment in this disease setting and men who choose this option may avoid palliative androgen deprivation therapy (ADT). The purpose of this study was to describe long-term outcomes and patient feedback following sRARP. Methods We reviewed data for consecutive men with biopsy-proven localized BCR who underwent sRARP and pelvic lymph node dissection at a single tertiary referral center between 2004 and 2021. Perioperative data, Clavien-Dindo complications, and functional outcomes were recorded. The Kaplan-Meier method was used to estimate prostate-specific antigen-free (≥0.2 ng/ml) survival (PSAFS) and metastasis-free survival (MFS). Three Likert-type items (score 1-5) from the validated Surgical Satisfaction Questionnaire-8 were distributed to patients postoperatively. Key findings and limitations We included 78 men, of whom 72 (92%) had undergone primary radiotherapy and six (8%) had received primary prostate ablation. Median follow-up was 10.1 yr (interquartile range 5.8-12.4). Final pathology identified ≥pT3N0M0 in 35 patients (45%) and positive margins in 23 (29%). The overall complication rate was 50%. Of the 26 (33%) major (grade ≥III) complications, anastomotic stricture (32%) was most common. The estimated 3-, 5-, and 10-yr survival rates were 85.6% and 80.2%, 83.5% for PSAFS (n = 11), and 74.1%, 83.5%, and 70.5% for MFS (n = 23), respectively. At last follow-up, postoperative ADT had been administered to 17 patients (22%), and 39 men (50%) remained alive a decade after sRARP. Continence and potency were maintained in 33/62 (53%) and 1/16 (6%) patients, respectively. Thirty-five respondents (45%) reported median questionnaire scores (≥4) in favor of sRARP. Limitations include the small single-center series and a single query point for patient feedback. Conclusions and clinical implications Long-term outcomes of sRARP suggest that the technical challenges and morbidity of the procedure are qualified by patient feedback and the opportunity to evade the morbidity and mortality of biochemically recurrent PC. Patient summary We reviewed the cancer outcomes and side effects of robot-assisted surgical removal of the prostate after treatment failure with radiation or ablation for prostate cancer. We found that this type of treatment has substantial risks and long-term side effects, but the surgery provides an opportunity to cure prostate cancer and/or avoid the consequences of indefinite hormonal treatment. Overall, most men who underwent this surgery were not disappointed with their decision despite the higher risks and consequences.
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Affiliation(s)
- Daniel J. Lama
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Kyle Thomas
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Basil Ferenczi
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Oluwatimilehin Okunowo
- Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Clayton S. Lau
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Bertram E. Yuh
- Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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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
| | | | - Gilles Créhange
- Department of Radiotherapy, Institut Curie, 75005 Paris, France;
| | - Guilhem Roubaud
- Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France;
| | | | - Laurent Brureau
- Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France; (E.B.); (L.B.)
| | | | - 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;
| | | | - 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
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Drobner J, Kaldany A, Shah MS, Ghodoussipour S. The Role of Salvage Radical Prostatectomy in Patients with Radiation-Resistant Prostate Cancer. Cancers (Basel) 2023; 15:3734. [PMID: 37509395 PMCID: PMC10378204 DOI: 10.3390/cancers15143734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
There are multiple treatment strategies for patients with localized prostate adenocarcinoma. In intermediate- and high-risk patients, external beam radiation therapy demonstrates effective long-term cancer control rates comparable to radical prostatectomy. In patients who opt for initial radiotherapy but have a local recurrence of their cancer, there is no unanimity on the optimal salvage approach. The lack of randomized trials comparing surgery to other local salvage therapy or observation makes it difficult to ascertain the ideal management. A narrative review of existing prospective and retrospective data related to salvage radical prostatectomy after radiation therapy was undertaken. Based on retrospective and prospective data, post-radiation salvage radical prostatectomy confers oncologic benefits, with overall survival ranging from 84 to 95% at 5 years and from 52 to 77% at 10 years. Functional morbidity after salvage prostatectomy remains high, with rates of post-surgical incontinence and erectile dysfunction ranging from 21 to 93% and 28 to 100%, respectively. Factors associated with poor outcomes after post-radiation salvage prostatectomy include preoperative PSA, the Gleason score, post-prostatectomy staging, and nodal involvement. Salvage radical prostatectomy represents an effective treatment option for patients with biochemical recurrence after radiotherapy, although careful patient selection is important to optimize oncologic and functional outcomes.
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Affiliation(s)
- Jake Drobner
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Alain Kaldany
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Mihir S Shah
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Saum Ghodoussipour
- Division of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
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Smigelski M, Wysock JS, Taneja S, Lepor H. Salvage Cryoablation and Robotic Seminal Vesiculectomy: A Novel Salvage Treatment for Locally Recurrent Prostate Cancer. J Endourol 2023. [PMID: 37300480 DOI: 10.1089/end.2023.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
The purpose of this report is to describe a novel salvage surgical technique combining cryo-ablation of the prostate and robotic excision of the seminal vesicle for locally recurrent prostate cancer of the seminal vesicle with or without prostate involvement following radiation therapy or focal therapy. Seven men with biopsy-proven locally recurrent prostate cancer involving the seminal vesicle with or without adjacent prostate following primary radiation or focal therapy underwent combined salvage focal cryoablation and robotic excision of the seminal vesicle. Descriptive statistics characterized the cohort and outcomes. Median follow up was 1.4 years. There were no surgical complications, and length of stay was one day in all cases. No patients experienced any new urinary incontinence following removal of the catheter. Erectile function was preserved in both men exhibiting pre-operative erections adequate for intercourse. Of the 4 patients developing recurrent disease, 3 involved only the contralateral seminal vesicle; they all underwent a second salvage focal cryoablation and robotic seminal vesiculectomy. One presenting with high-risk disease developed systematic metastasis. He is alive and managed with androgen deprivation therapy. One developed persistent local disease recurrence and is on androgen deprivation therapy. The other five are disease-free based on the most recent mpMRI and PSA. This study highlights the feasibility and effectiveness of salvage focal cryoablation and robotic seminal vesiculectomy as a salvage treatment for locally recurrent prostate cancer of the seminal vesicle with or without involvement of the prostate following primary radiation or focal therapy. Based on our outcomes, we recommend considering a bilateral salvage focal cryoablation and robotic seminal vesiculectomy in men with unilateral seminal vesicle recurrence following primary radiation therapy. We recommend unilateral salvage focal cryoablation and seminal vesiculectomy in men with unilateral seminal vesicle and prostate involvement following primary partial cryo-ablation provided no contralateral disease is identified.
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Affiliation(s)
- Michael Smigelski
- NYU Langone Health, 12297, Urology, 222 E. 41st St, 12th Floor, New York, New York, United States, 10017;
| | | | - Samir Taneja
- NYU Langone Health, 12297, Urology, New York, New York, United States;
| | - Herbert Lepor
- NYU Langone Health, 12297, Urology, 222 East 41st street, 12th floor, New York, New York, United States, 10017
- NYU, 5894, Urology, 222 East 41st St, New York, United States, 10012-1126;
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Nabavizadeh R, Karnes RJ. Salvage radical prostatectomy. Curr Opin Urol 2023; 33:163-167. [PMID: 36591993 DOI: 10.1097/mou.0000000000001074] [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: 01/03/2023]
Abstract
PURPOSE OF REVIEW Salvage radical prostatectomy (sRP) is underutilized because of fear of historical high rates of peri-operative morbidities. However, there has been significant improvements in complication rates as well as oncologic outcomes in the recent years. RECENT FINDINGS Complication rates have significantly declined for both open and robotic approach in the past decade. Rectal injury is now reported around 2%, which is down from 30% in the historic series. Similarly, the current risk of major vascular injury is low. About 75% of patients report social continence (up to one pad per day). However, erectile function recovery remains poor and patients should be counselled accordingly. Long-term durable oncologic response is achievable with 10-year recurrence-free survival reported in about 40-50% of well selected patients. SUMMARY Recent improvements in oncologic and peri-operative outcomes make sRP a desirable option for local control. sRP treats the whole gland as opposed to focal therapies and allows for pelvic lymph node dissection and removal of seminal vesicles, which can be sanctuary site of disease. In experienced hands, regardless of the surgical approach, sRP can achieve a durable response resulting in delaying or avoiding androgen deprivation therapy and its associated morbidities.
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Salvage Retzius-Sparing Radical Prostatectomy: A Review of Complications, Functional Outcomes, and Oncologic Outcomes. Curr Oncol 2022; 29:9733-9743. [PMID: 36547178 PMCID: PMC9777071 DOI: 10.3390/curroncol29120764] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
(Background) Radiation failure for localized prostate cancer is seen in 20-60% of patients who do not undergo extirpative surgery. Though potentially curative, salvage prostatectomy (SS) has not been frequently performed historically due to high rates of complications and postoperative incontinence. With the advent of robotic-assisted radical prostatectomy, these rates appear to be improved. Retzius-sparing approaches have additionally been shown to improve continence outcomes in the index setting, and may further improve continence outcomes in salvage cases while maintaining oncologic integrity. (Methods) We performed a literature review and qualitative analysis of published papers on salvage Retzius-sparing robotic-assisted radical prostatectomy (SRS). Three studies met criteria and were included in analysis. (Results) There were more patients with Gleason Grade Group 1 disease after initial treatment in the SRS group vs. SS (22% vs. 8%). Patients most frequently underwent external beam radiation therapy in both groups (52% vs. 49%). 30-day complication rates were 10% and 26% for SRS and SS, respectively. Continence outcomes were significantly improved in SRS with 59% of continence (based on study criteria) compared to 38% in SS. Time to continence was similarly improved for SRS. Positive surgical margins and biochemical recurrence were not significantly different between SRS and SS in any study. (Conclusions) SRS is a safe and feasible option for salvage treatment of localized prostate cancer and may improve postoperative continence outcomes. Positive surgical margin and biochemical recurrence rates are similar to those reported in SS.
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Marquis A, Marra G, Calleris G, Oderda M, Montefusco G, D'Agate D, Sotelo R, Sooriakumaran P, Walz J, Gontero P. Nightmares in Salvage Robot-assisted Radical Prostatectomy After Primary Radiation Therapy for Prostate Cancer: A Step by Step Tutorial. EUR UROL SUPPL 2022; 43:62-67. [PMID: 35942231 PMCID: PMC9356262 DOI: 10.1016/j.euros.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Salvage radical prostatectomy after primary radiotherapy (sRP) is considered a challenging procedure. We highlight the complications of sRP and detail critical surgical steps to help prevent them. A nonsystematic literature review in PubMed using the term “salvage radical prostatectomy” was performed on December 1, 2021. Salvage robot-assisted RP (sRARP) cases and imaging materials were used to create an educational video providing practical examples. Owing to radiation-induced changes in the prostate and surrounding tissues after radiotherapy, sRP is typically more challenging than primary RP. Among its critical steps are incision of the endopelvic fascia, bladder neck dissection with attempts at sparing the neck, development of posterior planes between the prostate and rectum, and dissection of the prostatic apex. Complication rates are significant, in particular for bladder neck contracture (0–16%) and anastomotic leakage (10–33%). Rectal injury is now rare (<2%) but still feared; careful adherence to surgical principles is required to avoid this complication. Functional outcomes are nonoptimal, with a high risk of urinary incontinence (severe incontinence in ∼25% of men). sRARP is a challenging urological procedure and should be performed by experienced surgeons. Thorough knowledge of the surgical anatomy and a meticulous technique for the most difficult surgical steps are crucial to minimise complications and to improve patient outcomes. Patient summary In patients with prostate cancer, removal of the prostate because of cancer recurrence after primary treatment with radiotherapy can be difficult because of radiation-induced tissue damage. This challenging procedure should be performed by experienced surgeons to minimise the risk of complications.
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Büchser D, Medina R, Mayrata E, González A, Marban M, Achard V, Alongi F, Gomez-Iturriaga A, Couñago F. Salvage local treatment for localized radio-recurrent prostate cancer: a narrative review and future perspectives. Future Oncol 2021; 17:4207-4219. [PMID: 34448402 DOI: 10.2217/fon-2021-0320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although dose escalation protocols have improved biochemical control in prostate cancer radiotherapy, 10-45% of patients will experience disease recurrence. The prostate and seminal vesicles are the most frequent site of the first relapse. Traditionally, these patients have been managed with hormonal therapy, which is not curative. Recent improvements in diagnostic tests (e.g., multiparametric magnetic resonance and molecular imaging, including PET/CT scan with choline or Ga-PSMA) and new treatment techniques (e.g., stereotactic body radiation therapy or other minimally invasive alternatives like high-intensity focus ultrasound, cryoablation or high-dose-rate brachytherapy) offer new therapeutic strategies with the potential to cure some patients with limited adverse effects. In this narrative review, the authors present the most recent evidence to help identify the most suitable candidates for salvage treatment.
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Affiliation(s)
- David Büchser
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Rafael Medina
- Urology, Virgen del Rocio University Hospital, Sevilla 41013, Spain
| | - Esther Mayrata
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Alba González
- Radiation Oncology, Basurto University Hospital, Bilbao 48013, Spain.,Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, 48903 Barakaldo, Spain
| | - Marina Marban
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Vérane Achard
- Radiation Oncology, Geneva University Hospital, Geneva 1205, Switzerland
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, Negrar 37024, Italy
| | - Alfonso Gomez-Iturriaga
- Radiation Oncology, Biocruces Health Research Institute, Cruces University Hospital, Barakaldo 48903, Spain
| | - Felipe Couñago
- Radiation Oncology, Quirón Salud University Hospital, Madrid 28223, Spain.,Radiation Oncology, La Luz Hospital, Madrid 28003, Spain.,Clinical Department, Universidad Europea de Madrid, Madrid 28670, Spain
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Salvage Radical Prostatectomy for Radio-Recurrent Prostate Cancer: An Updated Systematic Review of Oncologic, Histopathologic and Functional Outcomes and Predictors of Good Response. ACTA ACUST UNITED AC 2021; 28:2881-2892. [PMID: 34436018 PMCID: PMC8395524 DOI: 10.3390/curroncol28040252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
A valid treatment option for recurrence after definite radiotherapy (RT) for localized prostate cancer (PC) is salvage radical prostatectomy (SRP). However, data on SRP are scarce, possibly resulting in an underutilization. A systematic review was performed using MEDLINE (Pubmed), Embase, and Web of Science databases including studies published between January 1980 and April 2020. Overall, 23 English language articles including a total number of 2323 patients were selected according to PRISMA criteria. The overall median follow-up was 37.5 months (IQR 35.5–52.5). Biochemical-recurrence (BCR)-free probability ranged from 34% to 83% at five years, respectively, and from 31% to 37% at 10 years. Cancer specific survival (CSS) and overall survival (OS) ranged from 88.7% to 98% and 64% to 95% at five years and from 72% to 83% and 65% to 72% at 10 years, respectively. Positive surgical margins ranged from 14% to 45.8% and pathologic organ-confined disease was reported from 20% to 57%. The rate of pathologic > T2-disease ranged from 37% to 80% and pN1 disease differed between 0% to 78.4%. Pre-SRP PSA, pre-SRP Gleason Score (GS), pathologic stage after SRP, and pathologic lymph node involvement seemed to be the strongest prognostic factors for good outcomes. SRP provides accurate histopathological and functional outcomes, as well as durable cancer control. Careful patient counseling in a shared decision-making process is recommended.
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Wu SY, Wong AC, Shinohara K, Roach M, Cunha JAM, Valdes G, Hsu IC. Salvage High-Dose-Rate Brachytherapy for Recurrent Prostate Cancer After Definitive Radiation. Pract Radiat Oncol 2021; 11:515-526. [PMID: 34077809 DOI: 10.1016/j.prro.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Salvage high-dose-rate brachytherapy (sHDRBT) for locally recurrent prostate cancer after definitive radiation is associated with biochemical control in approximately half of patients at 3 to 5 years. Given potential toxicity, patient selection is critical. We present our institutional experience with sHDRBT and validate a recursive partitioning machines model for biochemical control. MATERIALS AND METHODS We performed a retrospective analysis of 129 patients who underwent whole-gland sHDRBT between 1998 and 2016. We evaluated clinical factors associated with biochemical control as well as toxicity. RESULTS At diagnosis the median prostate-specific antigen (PSA) was 7.77 ng/mL. A majority of patients had T1-2 (73%) and Gleason 6-7 (82%) disease; 71% received external beam radiation therapy (RT) alone, and 22% received permanent prostate implants. The median disease-free interval (DFI) was 56 months, and median presalvage PSA was 4.95 ng/mL. At sHDRBT, 46% had T3 disease and 51% had Gleason 8 to 10 disease. At a median of 68 months after sHDRBT, 3- and 5-year disease-free survival were 85% (95% CI, 79-91) and 71% (95% CI, 62-79), respectively. Median PSA nadir was 0.18 ng/mL, achieved a median of 10 months after sHDRBT. Patients with ≥35%+ cores and a DFI <4.1 years had worse biochemical control (19% vs 50%, P = .02). Local failure (with or without regional/distant failure) was seen in 11% of patients (14/129), and 14 patients (11%) developed acute urinary obstruction requiring Foley placement and 19 patients (15%) developed strictures requiring dilation. CONCLUSIONS sHDRBT is a reasonable option for patients with locally recurrent prostate cancer after definitive RT. Those with <35%+ cores or an initial DFI of ≥4.1 years may be more likely to achieve long-term disease control after sHDRBT.
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Affiliation(s)
- Susan Y Wu
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Anthony C Wong
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Katsuto Shinohara
- Department of Urology, University of California, San Francisco, California
| | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, California
| | - J Adam M Cunha
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California, San Francisco, California
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California, San Francisco, California.
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12
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Abstract
PURPOSE OF REVIEW Salvage surgeries are rarely offered and performed in prostate cancer except for isolated lymph node metastases. Meanwhile, data are sufficient that salvage radical prostatectomy is recommended by the guidelines. In the following review, we focus on different treatment strategies comparing open and DaVinci laparoscopic approach with regard to functional and oncologic outcome. Of further interest are palliative surgeries. RECENT FINDINGS Salvage radical prostatectomy is mainly performed in high volume centres. Data are increasing on minimal invasive surgery, although data on functional outcome are conflicting. As patients with prostate cancer have longer life expectancy even in metastasized disease, the possibility of developing symptomatic progression increases as well. We need to be aware that the confrontation with symptomatic prostate cancer patients will be more frequent in the future and that there are surgical approaches to palliate these patients sufficiently. SUMMARY Data on minimal invasive salvage radical prostatectomy are getting more valid and are an option in experienced centres. Salvage radical prostatectomy is a definitive curative option for the patients. To avoid local progression, palliative local surgeries need to be discussed with the patients.
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13
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Male sexual dysfunction and rehabilitation strategies in the settings of salvage prostate cancer treatment. Int J Impot Res 2021; 33:457-463. [PMID: 33854206 DOI: 10.1038/s41443-021-00437-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/08/2022]
Abstract
Male sexual dysfunction, a common sequela following primary prostate cancer (PC) treatment, is likely to be more significant following salvage PC therapy. In general, these impairments in sexual domains can be divided into three groups, namely (1) sexual desire, sexuality and masculinity; (2) erectile function (EF); and (3) ejaculation and orgasm. However, there is considerable overlap between these sexual domains and male sexual response cycle, and various factors such as cancer status, mental well-being, medical conditions and social circumstances can adversely impact on the male sexual function. While several preventive and treatment strategies for the preservation and recovery of sexual function are available, there is limited consensus guidelines exist regarding the optimal rehabilitation or treatment protocol for men with sexual dysfunction following salvage therapy. While penile rehabilitation may be effective to restore erectile function and the ability to have coital sex, there is lack of effective treatments in other domains of male sexual function, thereby underscoring the importance of psychological and sexual counselling in sexual rehabilitation. Indeed, a comprehensive multidisciplinary approach is necessary to better understand and optimally assist and manage the men and their respective partners for better sexual health and activity.
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14
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Woo HH, Teh A. Clinically significant localised prostate cancer: deciding what will provide the best clinical outcomes. Med J Aust 2021; 214:264-265. [PMID: 33751574 DOI: 10.5694/mja2.50983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Henry H Woo
- Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, NSW.,Chris O'Brien Lifehouse, Sydney, NSW
| | - Amy Teh
- Icon Cancer Centre, Sydney, NSW
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15
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Madi R, Sayyid RK, Hiffa A, Thomas E, Terris MK, Klaassen Z. Early Experience with Salvage Retzius-sparing Robotic-assisted Radical Prostatectomy: Oncologic and Functional Outcomes. Urology 2021; 149:117-121. [PMID: 33417926 DOI: 10.1016/j.urology.2020.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report on feasibility, safety, and continence outcomes using the Retzius-sparing approach in the salvage setting (sRS-RARP). MATERIALS AND METHODS A total of 26 patients underwent robotic salvage prostatectomy at our institution from January 2012 to May 2020 by a single surgeon (RM). Twenty patients underwent sRS-RARP and 6 underwent the standard approach (sRARP). Pre-, intra-, and postoperative outcomes were compared between these groups with emphasis on continence and oncologic safety. RESULTS Patients had comparable preoperative characteristics with no significant difference in age, race, prostate-specific antigen level, and Gleason score. Most patients underwent primary external beam radiation therapy (69.2%). Median time to biochemical failure was 7.9 years (IQR 6.1-13.4). sRS-RARP required less console time (141.5 vs 199.5.0 minutes, P = .008) and less blood loss (50.0 mL vs 100.0 mL, P = .045) compared to sRARP. Postoperative course was uneventful with a median hospital stay of 1 day. Median catheterization time was 14.0 days (IQR 11.5-17). Patients undergoing sRS-RARP had better immediate (25.0% vs 0.0%, P < .001), 3 month (80.0% vs 0%, P < .001), and 12 month continence rates (100% vs 44%, P = .0384) compared to sRARP patients. Likewise, median time to continence was significantly shorter for sRS-RARP patients (90.0 vs 270.0 days, P = .0095). Biochemical recurrence rate was 20.0% in the sRS-RARP group and 33.3% in the sRARP group (P = .60). CONCLUSION Early experience suggests that sRS-RARP is feasible, oncologically safe, and may offer improved continence compared to the sRARP approach.
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Affiliation(s)
- Rabii Madi
- Division of Urology, Department of surgery, Augusta University Health, Augusta, GA.
| | - Rashid K Sayyid
- Division of Urology, Department of surgery, Augusta University Health, Augusta, GA
| | - Anthony Hiffa
- Division of Urology, Department of surgery, Augusta University Health, Augusta, GA
| | - Eric Thomas
- Division of Urology, Department of surgery, Augusta University Health, Augusta, GA
| | - Martha K Terris
- Division of Urology, Department of surgery, Augusta University Health, Augusta, GA
| | - Zachary Klaassen
- Division of Urology, Department of surgery, Augusta University Health, Augusta, GA
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16
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Bonet X, Moschovas MC, Onol FF, Bhat KR, Rogers T, Ogaya-Pinies G, Rocco B, Sighinolfi MC, Woodlief T, Vigués F, Patel V. The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study. Minerva Urol Nephrol 2020; 73:600-609. [PMID: 33256361 DOI: 10.23736/s2724-6051.20.04077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to report the overall results and the learning curve (LC) in salvage robot-assisted radical prostatectomy (sRARP) patients, in terms of morbidity, oncological and functional outcomes in a single surgeon tertiary-referral center. METHODS One hundred and twenty patients underwent sRARP by a single surgeon (V.P.) from 2008 to 2018. To assess the trends in the learning experience they were sub-divided in 4 groups of 30 consecutive patients based on date of surgery. The Kaplan-Meier method and regression models were used to identify survival estimations and predictors of potency, continence and biochemical failure (BCF) at 12 months. RESULTS As the learning experience for sRALP increased operative time (OT) was significantly shorter (from 139.5 to 121 minutes) and the amount of nerve-sparing (NS) undertaken increased (from 46% to 80%). While complications rate remained stable, estimated blood loss (EBL) and radiographic anastomotic leaks (RAL) decreased through the groups (from 124 to 69 ml and 40% to 16,7%, respectively). BCF and continence rates at 12 months after sRARP were similar among groups (23-36% and 36,7-50%, respectively) and chance of potency rates tended to increase (from 3.3% to 16-23%) but was not statistically significant. In a multivariate analysis, predictors for BCF were PSM and GS 8-10. Non-radiation primary treatment was the unique predictor of continence at 12 months after sRARP. CONCLUSIONS Our data may suggest a decreasing trend in terms of OT and EBL through the sRARP learning curve. While morbidity remained stable through the time, RAL trended towards a decline. A higher degree of NS was observed through the groups and there was a slight correlation trend between surgical expertise and potency recovery. PSM and GS 8-10 were predictors of BCF and non-radiation primary treatment predicted a better continence after sRARP.
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Affiliation(s)
- Xavier Bonet
- Bellvitge University Hospital, Barcelona, Spain - .,Advent Health Global Robotics Institute, Celebration, FL, USA -
| | | | - Fikret F Onol
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Kulthe R Bhat
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Gabriel Ogaya-Pinies
- Advent Health Global Robotics Institute, Celebration, FL, USA.,Rey Juan Carlos University Hospital, Madrid, Spain
| | - Bernardo Rocco
- Advent Health Global Robotics Institute, Celebration, FL, USA.,University of Modena and Reggio Emilia, Modena, Italy
| | | | - Tracey Woodlief
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | | | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, FL, USA
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17
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Salvage low dose rate brachytherapy for prostate cancer recurrence following definitive external beam radiation therapy. Radiother Oncol 2020; 155:42-47. [PMID: 33075391 DOI: 10.1016/j.radonc.2020.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We sought to describe the safety and efficacy of salvage low dose rate (LDR) brachytherapy for local prostate cancer recurrence following definitive RT. MATERIALS AND METHODS We included patients from two prospectively maintained institutional databases who underwent salvage LDR brachytherapy for biopsy confirmed intra-prostatic recurrence following primary RT. All patients were without evidence of metastatic disease. Freedom from biochemical failure (FFbF), prostate cancer specific survival (PCaSS), and overall survival (OS) were determined using the Kaplan-Meier estimates. Cox proportional hazard models were used to identify factors predictive of FFbF. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS 108 patients were included. Median follow-up was 6.3 years. The 5- and 10-year actuarial survival outcomes were as follows: FFbF, 63.1% and 52.0%; PCaSS, 90.5% and 77.8%; OS, 80.9% and 56.7%. On multivariate modeling, increasing grade group (HR 1.41, 95% CI 1.02-1.95, p = 0.036) and initial PSA at diagnosis (HR 1.02, 95% CI 1.004-1.05, p = 0.022) were associated with worse FFbF. Grade 3 toxicity occurred in 16.7% of patients; including genitourinary events in 15.7% and gastrointestinal events in 2.8% of patients. IPSS scores increased following implant, peaking at 2 months (median IPSS 20, p = 0.002) and thereafter remaining elevated throughout follow-up. CONCLUSIONS Salvage LDR brachytherapy is safe and efficacious, with acceptable grade 3+ toxicity and good biochemical control on long-term follow-up. Patients with higher grade group and higher PSA at initial diagnosis may be at increased risk for biochemical failure.
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18
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Corkum MT, Mendez LC, Chin J, D’Souza D, Boldt RG, Bauman GS. A Novel Salvage Option for Local Failure in Prostate Cancer, Reirradiation Using External Beam or Stereotactic Radiation Therapy: Systematic Review and Meta-Analysis. Adv Radiat Oncol 2020; 5:965-977. [PMID: 33083660 PMCID: PMC7557139 DOI: 10.1016/j.adro.2020.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/11/2020] [Accepted: 04/25/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Reirradiation (re-RT) using external beam radiation therapy (EBRT) is a novel salvage strategy for local failure in prostate cancer. We performed a systematic review describing oncologic and toxicity outcomes for salvage EBRT/stereotactic radiation therapy (SBRT) re-RT. Methods and Materials A International Prospective Register of Systematic Reviews registered (#141466) systematic review, meta-analysis, and meta-regression was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed and EMBASE were searched from inception through September 2019. Outcome measures included local control (LC), biochemical relapse free survival (BRFS), and ≥grade 3 genitourinary (GU)/gastrointestinal (GI) toxicity. EBRT and SBRT data were collected separately. Meta-regression explored disease and toxicity outcomes as a function of equivalent dose in 2 Gy fractions (EQD2), length of follow-up, and partial versus whole prostate reirradiation. Results Nineteen studies representing 13 cohorts were included (428 patients). Weighted mean follow-up was 26.1 months. Median re-RT EQD2 was 77.1 Gy (α/β = 1.5), with 92% of patients receiving SBRT, 52.1% of patients receiving partial prostate re-RT, and 30.1% of patients receiving androgen deprivation therapy with re-RT. LC was 83.2% (95% confidence interval [CI], 75.5%-90.9%) and BRFS was 59.3% (47.9%-70.7%). Reported late toxicity ≥grade 3 was 3.4% (95% CI, 1.0%-5.8%) for GU and 2.0% (95% CI, 0.1%-4.0%) for GI. Meta-regression found higher LC, BRFS, and reported GU/GI toxicity with increasing EQD2, with partial prostate re-RT associated with less reported GU/GI toxicity and no detriment to LC and BRFS. Conclusions Salvage re-RT using EBRT, particularly with SBRT, is an emerging technique to treat isolated local failure of prostate cancer. With short-term follow-up, LC, BRFS, and reported toxicities appear reasonable, although further follow-up is required before definitive statements on late toxicities can be made. Our review is limited by incomplete reporting of androgen deprivation therapy use in the primary literature. Further prospective studies and longer follow-up are needed before considering re-RT as standard practice.
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Affiliation(s)
- Mark T. Corkum
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Lucas C. Mendez
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Joseph Chin
- Department of Urology, London Health Sciences Centre, London, Canada
| | - David D’Souza
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - R. Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
| | - Glenn S. Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Canada
- Corresponding author: Glenn S. Bauman, MD
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19
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Fuller D, Wurzer J, Shirazi R, Bridge S, Law J, Crabtree T, Mardirossian G. Retreatment for Local Recurrence of Prostatic Carcinoma After Prior Therapeutic Irradiation: Efficacy and Toxicity of HDR-Like SBRT. Int J Radiat Oncol Biol Phys 2020; 106:291-299. [DOI: 10.1016/j.ijrobp.2019.10.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/27/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022]
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20
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Onol FF, Bhat S, Moschovas M, Rogers T, Ganapathi H, Roof S, Rocco B, Patel V. Comparison of outcomes of salvage robot-assisted laparoscopic prostatectomy for post-primary radiation vs focal therapy. BJU Int 2019; 125:103-111. [PMID: 31430422 DOI: 10.1111/bju.14900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare salvage robot-assisted laparoscopic prostatectomy (RALP) outcomes in patients who underwent radiation and those who underwent focal ablation as primary therapies. PATIENTS AND METHODS We evaluated 126 patients who underwent salvage RALPbetween 2008 and 2018. Of these, 94 (74.6%) received radiation and 32 focal ablation (25.4%) as primary therapy. These groups were compared with regard to clinical, oncological and functional outcomes. Kaplan-Meier curves and regression models were used to identify survival estimations and their predictors. RESULTS Before surgery, more patients were potent in the focal ablation group compared to the radiation group (46.9% vs 22.6%; P = 0.013). Peri-operative characteristics and complication rates were not significantly different between the two groups. Postoperative catheterization duration was shorter in the focal ablation group (mean 10 vs 16 days; P = 0.018). At final pathology, the focal ablation group had higher non-organ-confined disease (71% vs 50%; P = 0.042) and positive surgical margin (PSM) rates (43.8% vs 17%; P = 0.004) as compared to the radiation group; however, 5-year biochemical recurrence (BCR)-free survival rates were similar (59% vs 56%; P = 0.761). Postoperative 1-year full (no pads/day) and social (0-1 pad/day) continence rates were significantly higher in the focal ablation as compared to the radiation group (77.3% vs 39.2%, P = 0.002, and 87.5% vs 51.3%, P = 0.002, respectively). Multivariate analyses showed primary focal ablation and nerve-sparing to be predictors of postoperative continence. Erectile function was preserved in 13% and 27% of preoperatively potent patients in the radiation and focal ablation groups, respectively (P = 0.435). No predictors were identified for postoperative potency. CONCLUSIONS Radiation was associated with inferior functional outcomes after salvage RALP. Focal therapies were associated with higher non-organ-confined disease and PSMrates, with no significant difference in short-term BCR-free survival.
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Affiliation(s)
| | - Seetharam Bhat
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | | | - Travis Rogers
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | | | - Shannon Roof
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, FL, USA
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21
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Salvage Local Treatments After Focal Therapy for Prostate Cancer. Eur Urol Oncol 2019; 2:526-538. [DOI: 10.1016/j.euo.2019.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 12/13/2022]
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22
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Hostiou T, Gelet A, Chapelon JY, Rouvière O, Mège-Lechevalier F, Lafon C, Tonoli-Catez H, Badet L, Crouzet S. Salvage high-intensity focused ultrasound for locally recurrent prostate cancer after low-dose-rate brachytherapy: oncological and functional outcomes. BJU Int 2019; 124:746-757. [PMID: 31148367 DOI: 10.1111/bju.14838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate the oncological and functional outcomes of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after low-dose-rate (LDR) brachytherapy. PATIENTS AND METHODS Clinical phase II studies (2003-2015) included 50 consecutive patients with post-brachytherapy local recurrence treated by S-HIFU. S-HIFU was performed with post-external beam radiotherapy (EBRT) parameters and, since 2008, with specific post-brachytherapy parameters. Treatments were whole-gland ablation and, since 2009, hemi-ablation in cases of unilateral prostate cancer. The primary objective was to assess oncological outcomes: treatment failure-free survival, progression-free survival (PFS), overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) rates. The secondary objective was to evaluate adverse events, continence, and erectile function. Kaplan-Meier analysis estimated oncological outcomes. RESULTS In all, 13 patients were treated with post-EBRT parameters, 37 with post-brachytherapy parameters, 35 with whole-gland treatment, and 15 with hemi-ablation. The median follow-up was 4.6 years. After S-HIFU, the median prostate-specific antigen level was 0.3 ng/mL. At 6 years, treatment failure-free survival, PFS, OS, CSS, and MFS rates were 41%, 45%, 93%, 98%, and 80%, respectively. Post-brachytherapy compared with post-EBRT parameters reduced Grade 2-3 incontinence (34% vs 62%, P = 0.015). Incontinence, bladder outlet obstruction and Grade ≥III complications were significantly reduced with hemi-ablation compared with whole-gland treatment (14% vs 54%, P < 0.001; 13% vs 46%, P = 0.03; 13% vs 63%, P = 0.001; respectively). Before S-HIFU, 25 patients had a five-item version of the International Index of Erectile Function score of ≥17, which was maintained in 48% at 12 months. CONCLUSION S-HIFU for locally recurrent prostate cancer after LDR brachytherapy is associated with favourable survival rates at a price of significant morbidity. Dedicated post-brachytherapy parameters and hemi-ablation improve the safety of the treatment.
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Affiliation(s)
- Thomas Hostiou
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
| | - Albert Gelet
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
| | | | - Olivier Rouvière
- Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France.,Department of Radiology, Edouard Herriot Hospital, Lyon, France
| | | | - Cyril Lafon
- INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
| | - Hélène Tonoli-Catez
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France
| | - Lionel Badet
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France
| | - Sébastien Crouzet
- Department of Urology and Transplantation Surgery, Edouard Herriot Hospital, Lyon, France.,Department of Urology, Université de Lyon, Lyon, France.,INSERM Unit 1032, LabTau, Université de Lyon, Lyon, France
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23
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Calleris G, Marra G, Dalmasso E, Falcone M, Karnes RJ, Morlacco A, Oderda M, Sanchez-Salas R, Soria F, Gontero P. Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. World J Urol 2019; 37:1469-1483. [DOI: 10.1007/s00345-019-02749-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 03/28/2019] [Indexed: 12/01/2022] Open
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Outcomes after salvage radical prostatectomy and first-line radiation therapy or HIFU for recurrent localized prostate cancer: results from a multicenter study. World J Urol 2019; 37:1491-1498. [PMID: 30790014 DOI: 10.1007/s00345-019-02683-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Despite no consensus on the optimal management of recurrent prostate cancer after primary radiation or HIFU therapy, salvage prostatectomy (sRP) is reserved for only 3% of patients because of technical challenges and frequent post-operative complications. We assessed outcomes after sRP in a series of patients with localized PCa and that had received radiation therapy or HIFU as a first-line treatment. MATERIALS AND METHODS Data from nine French referral centers on patients treated with sRP between 2005 and 2017 were collected. Pre- and post-operative data, including oncological and functional outcomes after first treatment and sRP, were analyzed to determine the predictors for biochemical recurrence (BCR) and cancer-specific survival (CSS) after sRP. RESULTS First-line treatments were external beam-radiation therapy (EBRT) for 30 (55%), brachytherapy (BT) for 10 (18%), and high-intensity focused ultrasound (HIFU) for 15 (27%). Median (IQR) PSA at diagnosis was 6.4 (4.9-9.5) ng/mL, median PSA at nadir was 1.9 (0.7-3.0) ng/mL, and median (IQR) to first BCR was 13 (6-20) months. Of the 55 patients, 44 (80%) received robot-assisted salvage radical prostatectomy and 11 (20%) received salvage retropubic radical prostatectomy. Restoration of continence was achieved in 90% of preoperatively continent patients; 24% that had received nerve-sparing (NS) procedures were potent after surgery. Prolonged catheterization due to anastomotic leakage was the most common complication. Age, preoperative clinical stage, NS procedure, and a pathological Gleason score were predictors for BCR. CONCLUSIONS sRP was safe, feasible, and effective using either an open or robot-assisted approach, in experienced hands. Age, preoperative clinical stage, NS procedure, and pathological GS were linked with BCR after sRP.
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25
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Mohler JL, Halabi S, Ryan ST, Al-Daghmin A, Sokoloff MH, Steinberg GD, Sanford BL, Eastham JA, Walther PJ, Morris MJ, Small EJ. Management of recurrent prostate cancer after radiotherapy: long-term results from CALGB 9687 (Alliance), a prospective multi-institutional salvage prostatectomy series. Prostate Cancer Prostatic Dis 2018; 22:309-316. [PMID: 30385835 DOI: 10.1038/s41391-018-0106-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/09/2018] [Accepted: 09/29/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate efficacy and morbidity prospectively in a contemporary multi-institutional salvage radical prostatectomy (SRP) series. METHODS Forty-one men were enrolled between 1997 and 2006, who suffered biopsy-proven recurrent prostate cancer (CaP) after receiving ≥ 60c Gy radiation as primary treatment for cT1-2NXM0 disease. Surgical morbidity, quality of life, biochemical progression-free survival (BPFS) and overall survival (OS) were evaluated. RESULTS Twenty-four men had undergone external beam radiotherapy, 11 brachytherapy, and six both. Median time between radiation and SRP was 64 months. Median age at SRP was 64 years. Pathologic staging revealed 44% pT2, 54% pT3, and 3% pT4. Surgical margins were positive in 17 and 88% were pN0. Twenty-two percent required intraoperative blood transfusion. Three rectal and one obturator nerve injuries occurred. Seventeen of 38 evaluable patients (45%) had urinary incontinence ( ≥ 3 pads/day) prior to SRP; 88% reported urinary incontinence at 6 months, 85% at 12 months, 63% at 24 months after SRP. Furthermore, 37% of men reported impotence prior to SRP; 78% reported impotence at 6 months, 82% at 12 months, and 44% at 24 months after SRP. The 2-, 5- and 10-year BPFS rates were 51, 39, and 33% respectively; the 2-, 5- and 10-year OS rates were 100, 89, and 52%, respectively, at median follow-up 91 months. CONCLUSIONS Modern surgical techniques continue to be associated with significant peri-operative complication rates. Nevertheless, SRP may benefit carefully selected patients through durable oncologic control.
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Affiliation(s)
- James L Mohler
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States.
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - Stephen T Ryan
- University of California San Diego, La Jolla, CA, United States
| | - Ali Al-Daghmin
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States
| | | | | | - Ben L Sanford
- Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - James A Eastham
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Philip J Walther
- Duke University Medical Center, Durham, NC, CA47577, United States
| | - Michael J Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Eric J Small
- University of California at San Francisco, San Francisco, CA, CA60138, United States
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Bonet X, Ogaya-Pinies G, Woodlief T, Hernandez-Cardona E, Ganapathi H, Rogers T, Coelho RF, Rocco B, Vigués F, Patel V. Nerve-sparing in salvage robot-assisted prostatectomy: surgical technique, oncological and functional outcomes at a single high-volume institution. BJU Int 2018; 122:837-844. [PMID: 30126045 DOI: 10.1111/bju.14517] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To show the feasibility, oncological and functional outcomes of neurovascular bundle (NVB) preservation during salvage robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS In the present institutional review board-approved retrospective analysis, between January 2008 and March 2016, 80 patients underwent salvage RARP, performed by a single surgeon (V.P), because of local recurrence after primary treatment. These patients were categorized into two groups depending on the degree of nerve-sparing (NS) performed: a good-NS group (≥50% of NVB preservation) and a poor-NS group (<50% of NVB preservation). A standard transperitoneal six-port technique, using the DaVinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA), was performed, and either an anterograde or a retrograde approach was used for NVB preservation. Validated questionnaires were used preoperatively (Sexual Health Inventory for Men [SHIM] and American Urological Association scores). Potency after salvage RARP was defined as the ability to achieve a successful erection with penetration >50% of the time, while full continence after salvage RARPwas defined as 0 pads used. The Kaplan-Meier method was used for survival and predictive estimations, and regression models were used to identify the predictors of potency, continence and biochemical failure (BCF). RESULTS The potency rate at 12 months was higher in the good-NS group (25.6% vs 4.3%; P = 0.036) regardless of previous SHIM score, and good NS tended to be predictive of potency after salvage RARP (P = 0.065). The full continence rate at 12 months and BCF rate were similar in the two groups, and non-radiation primary treatment was the only predictor of continence at 12 months after salvage RARP (P = 0.033). CONCLUSIONS Our data support the feasibility and safety of NVB preservation for salvage RARP conducted in select patients in a high-volume institution and the subsequent better recovery of adequate erections for intercourse.
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Affiliation(s)
- Xavier Bonet
- Hospital Universitari de Bellvitge, Barcelona, Spain.,Global Robotic Institute, Florida Hospital, Celebration, FL, USA
| | | | - Tracey Woodlief
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA
| | | | | | - Travis Rogers
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA
| | - Rafael F Coelho
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA.,University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Bernardo Rocco
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA.,Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Vipul Patel
- Global Robotic Institute, Florida Hospital, Celebration, FL, USA
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Pal RP, Koupparis AJ. Expanding the indications of robotic surgery in urology: A systematic review of the literature. Arab J Urol 2018; 16:270-284. [PMID: 30147957 PMCID: PMC6105341 DOI: 10.1016/j.aju.2018.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives To evaluate the recent developments in robotic urological surgery, as the introduction of robotic technology has overcome many of the difficulties of pure laparoscopic surgery enabling surgeons to perform complex minimally invasive procedures with a shorter learning curve. Robot-assisted surgery (RAS) is now offered as the standard for various surgical procedures across multiple specialities. Methods A systematic search of MEDLINE, PubMed and EMBASE databases was performed to identify studies evaluating robot-assisted simple prostatectomy, salvage radical prostatectomy, surgery for urolithiasis, distal ureteric reconstruction, retroperitoneal lymph node dissection, augmentation ileocystoplasty, and artificial urinary sphincter insertion. Article titles, abstracts, and full text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis. Results In all, 72 studies evaluating the above techniques were identified. Almost all studies were retrospective single-arm case series. RAS appears to be associated with reduced morbidity, less blood loss, reduced length of stay, and comparable clinical outcomes in comparison to the corresponding open procedures, whilst having a shorter operative duration and learning curve compared to the equivalent laparoscopic techniques. Conclusion Emerging data demonstrate that the breadth and complexity of urological procedures performed using the da Vinci® platform (Intuitive Surgical Inc., Sunnyvale, CA, USA) is continually expanding. There is a gaining consensus that RAS is producing promising surgical results in a wide range of procedures. A major limitation of the current literature is the sparsity of comparative trials evaluating these procedures.
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Key Words
- (L)(R)RP, (laparoscopic)(retropubic)radical prostatectomy
- (L)(RA) PN, (laparoscopic)(robot-assisted) partial nephrectomy
- (L-)(O-)(R-) RPLND, (laparoscopic)(open)(robot-assisted) retroperitoneal lymph node dissection
- (O)(L)(RA)SP, (open)(laparoscopic)(robot-assisted)simple prostatectomy
- (RA)RC, (robot-assisted) radical cystectomy
- (S)UI, (stress) urinary incontinence
- (s)RALP, (salvage)robot-assisted laparoscopic prostatectomy
- AUS, artificial urinary sphincter
- HoLEP, holmium laser enucleation of the prostate
- ICUD, intracorporeal urinary diversion
- LOS, length of hospital stay
- MIS, minimally invasive surgery
- PCNL, percutaneous nephrolithotomy
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- RAI, robot-assisted augmentation ileocystoplasty
- RAS, robot-assisted surgery
- RCT, randomised controlled trial
- RNL, robot-assisted nephrolithotomy
- RPL, robot-assisted pyelolithotomy
- Robot-assisted surgery
- Robotic surgery
- Urology
- sRRP, salvage RRP
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Affiliation(s)
- Raj P Pal
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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28
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Ogaya-Pinies G, Linares-Espinos E, Hernandez-Cardona E, Jenson C, Cathelineau X, Sanchez-Salas R, Patel V. Salvage robotic-assisted radical prostatectomy: oncologic and functional outcomes from two high-volume institutions. World J Urol 2018; 37:1499-1505. [PMID: 30006908 DOI: 10.1007/s00345-018-2406-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/08/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION While no consensus on the optimal salvage treatment exists, only 3% of these patients will get salvage radical prostatectomies due to the assumed technical challenges of this procedure. OBJECTIVES Our goal is to analyze the perioperative, oncologic and functional outcomes of patients undergoing salvage robotic-assisted radical prostatectomy (sRARP) after primary treatment failure. MATERIALS AND METHODS Data were prospectively collected and retrospectively reviewed from a combined database of more than 14,800 patients who had undergone RARP. We identified 96 patients who underwent sRARP after RT or ablative techniques. Primary cancer characteristics, surgical data, pathology results, perioperative complications, oncologic and functional outcomes were analyzed. RESULTS Sixty-eight patients (70.8%) received some source of RT as a primary treatment. The remaining 28 patients: 18 (18.75%) received cryotherapy, seven (7.92%) HIFU, one electroporation, one microwave and one Tookad. complication was seen in 25 (26%) patients (21 minor and 4 major complications). Anastomotic leak was the most common complication, found in 14 (14.6%) of the cases. No rectal injuries occurred. Fourteen (15%) patients had a biochemical failure after a median follow-up of 14 (IQR 5-24) months. Fifty-five (57.3%) of them self-reported to be pad-free at 12 months. Seventeen (55%) of 31 pre-operative potent patients (SHIM score > 21), were potent with or without the use of PDE5i at 12 months. CONCLUSIONS sRARP is a feasible alternative for PCa recurrence. Technically the procedure is challenging and should be performed by experienced PCa surgeons. Major complications are uncommon. Continence and potency recovery is possible, but at lower rates than for non-salvage patients.
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Affiliation(s)
- Gabriel Ogaya-Pinies
- Hospital Universitario Rey Juan Carlos, C/Gladiolo s/n, 28933, Mostoles, Madrid, Spain.
| | | | - Eduardo Hernandez-Cardona
- University of Central, Florida School of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | - Cathy Jenson
- University of Central, Florida School of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
| | | | | | - Vipul Patel
- University of Central, Florida School of Medicine and Global Robotics Institute, Florida Hospital-Celebration Health, Celebration, FL, USA
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Tisseverasinghe SA, Crook JM. The role of salvage brachytherapy for local relapse after external beam radiotherapy for prostate cancer. Transl Androl Urol 2018; 7:414-435. [PMID: 30050801 PMCID: PMC6043745 DOI: 10.21037/tau.2018.05.09] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Prostate cancer is the most prevalent cancer amongst men. For localized disease, there currently exist several reliable treatment modalities including surgery, radiotherapy and brachytherapy. Our growing understanding of this disease indicates that local control plays a very important role in prevention of subsequent dissemination. Many improvements to external beam radiotherapy over recent years have decreased toxicity and improved outcomes, but nonetheless, local relapse remains common. Many salvage options exist for locally recurrent prostate cancer, but are rarely offered, partly because of the fear of toxicity. Many men with isolated local recurrence therefore do not receive potentially curative second line treatment and are instead treated with palliative androgen suppression. Selection plays an important role in determining which individuals are likely to benefit from salvage. Those at high risk of pre-existing micro-metastatic disease despite negative staging scans are unlikely to benefit. Prostate brachytherapy has evolved over the more than 3 decades of experience. Modern techniques allow more precise tumor localization and dose delivery. Better understanding of dosimetric parameters can distinguish optimal from suboptimal implants. Salvage brachytherapy can be an effective treatment for locally recurrent prostate cancer after prior external beam radiotherapy. We review the literature pertaining to both low dose rate (LDR) and high dose rate (HDR) salvage brachytherapy and discuss patient selection, optimal dose, treatment volume and toxicity avoidance.
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Affiliation(s)
- Steven A Tisseverasinghe
- BC Cancer Agency Centre for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
| | - Juanita M Crook
- BC Cancer Agency Centre for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
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30
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Bandini M, Gandaglia G, Fossati N, Montorsi F, Briganti A. Anastomotic leaks and catheter time after salvage robot-assisted radical prostatectomy. Transl Androl Urol 2018; 7:S141-S143. [PMID: 29644184 PMCID: PMC5881216 DOI: 10.21037/tau.2017.03.86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco Bandini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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31
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Fakhrejahani F, Madan RA, Dahut WL. Management Options for Biochemically Recurrent Prostate Cancer. Curr Treat Options Oncol 2017; 18:26. [PMID: 28434181 DOI: 10.1007/s11864-017-0462-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prostate cancer is the most common solid tumor malignancy in men worldwide. Treatment with surgery and radiation can be curative in organ-confined disease. Unfortunately, about one third of men develop biochemically recurrent disease based only on rising prostate-specific antigen (PSA) in the absence of visible disease on conventional imaging. For these patients with biochemical recurrent prostate cancer, there is no uniform guideline for subsequent management. Based on available data, it seems prudent that biochemical recurrent prostate cancer should initially be evaluated for salvage radiation or prostatectomy, with curative intent. In selected cases, high-intensity focused ultrasound and cryotherapy may be considered in patients that meet very narrow criteria as defined by non-randomized trials. If salvage options are not practical or unsuccessful, androgen deprivation therapy (ADT) is a standard option for disease control. While some patients prefer ADT to manage the disease immediately, others defer treatment because of the associated toxicity. In the absence of definitive randomized data, patients may be followed using PSA doubling time as a trigger to initiate ADT. Based on retrospective data, a PSA doubling time of less than 3-6 months has been associated with near-term development of metastasis and thus could be used signal to initiate ADT. Once treatment is begun, patients and their providers can choose between an intermittent and continuous ADT strategy. The intermittent approach may limit side effects but in patients with metastatic disease studies could not exclude a 20% greater risk of death. In men with biochemical recurrence, large studies have shown that intermittent therapy is non-inferior to continuous therapy, thus making this a reasonable option. Since biochemically recurrent prostate cancer is defined by technological limitations of radiographic detection, as new imaging (i.e., PSMA) strategies are developed, it may alter how the disease is monitored and perhaps managed. Furthermore, patients have no symptoms related to their disease and thus many prefer options that minimize toxicity. For this reason, herbal agents and immunotherapy are under investigation as potential alternatives to ADT and its accompanying side effects. New therapeutic options combined with improved imaging to evaluate the disease may markedly change how biochemically recurrent prostate cancer is managed in the future.
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Affiliation(s)
- Farhad Fakhrejahani
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1906, Bethesda, 20892, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1906, Bethesda, 20892, USA
| | - William L Dahut
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Dr, MSC 1906, Bethesda, 20892, USA.
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32
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Crouzet S, Blana A, Murat FJ, Pasticier G, Brown SCW, Conti GN, Ganzer R, Chapet O, Gelet A, Chaussy CG, Robertson CN, Thuroff S, Ward JF. Salvage high-intensity focused ultrasound (HIFU) for locally recurrent prostate cancer after failed radiation therapy: Multi-institutional analysis of 418 patients. BJU Int 2017; 119:896-904. [PMID: 28063191 DOI: 10.1111/bju.13766] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the oncological outcome of salvage high-intensity focused ultrasound (S-HIFU) for locally recurrent prostate cancer after external beam radiotherapy (EBRT) from a multicentre database. PATIENTS AND METHODS This retrospective study comprises patients from nine centres with local recurrent disease after EBRT treated with S-HIFU from 1995 to 2009. The biochemical failure-free survival (bFFS) rate was based on the 'Phoenix' definition (PSA nadir + 2 ng/mL). Secondary endpoints included progression to metastasis and cancer-specific death. Kaplan-Meier analysis was performed examining overall (OS), cancer-specific (CSS) and metastasis-free survival (MFS). Adverse events and quality of life status are reported. RESULTS In all, 418 patients with a mean (SD) follow-up of 3.5 (2.5) years were included. The mean (SD) age was 68.6 (5.8) years and the PSA level before S-HIFU was 6.8 (7.8) ng/mL. The median PSA nadir after S-HIFU was 0.19 ng/mL. The OS, CSS and MFS rates at 7 years were 72%, 82% and 81%, respectively. At 5 years the bFFS rate was 58%, 51% and 36% for pre-EBRT low-, intermediate- and high-risk patients, respectively. The 5-year bFFS rate was 67%, 42% and 22% for pre-S-HIFU PSA level ≤4, 4-10 and ≥10 ng/mL, respectively. Complication rates decreased after the introduction of specific post-RT parameters: incontinence (grade II or III) from 32% to 19% (P = 0.002); bladder outlet obstruction or stenosis from 30% to 15% (P = 0.003); recto-urethral fistula decreased from 9% to 0.6% (P < 0.001). Study limitations include being a retrospective analysis from a registry with no control group. CONCLUSION S-HIFU for locally recurrent prostate cancer after failed EBRT is associated with 7-year CSS and MFS rates of >80% at a price of significant morbidity. S-HIFU should be initiated early following EBRT failure.
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Affiliation(s)
| | - Andreas Blana
- Department of Urology, Fuerth Hospital, Fürth, Germany
| | | | | | | | | | - Roman Ganzer
- Department of Urology, University of Regensburg, Regensburg, Germany
| | - Olivier Chapet
- Department of Radiation Oncology, Lyon Sud Hospital, Pierre Bénite, France
| | - Albert Gelet
- Department of Urology, Edouard Herriot Hospital, Lyon, France
| | | | | | - Stefan Thuroff
- Department of Urology, Harlaching Hospital, Munich, Germany
| | - John F Ward
- Department of Urology, M. D. Anderson Cancer Center, Houston, TX, USA
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Use of Scaffolding Tissue Biografts To Bolster Vesicourethral Anastomosis During Salvage Robot-assisted Prostatectomy Reduces Leak Rates and Catheter Times. Eur Urol 2016; 74:92-98. [PMID: 27751731 DOI: 10.1016/j.eururo.2016.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/03/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND One of the key factors contributing to morbidity associated with salvage radical prostatectomy is a significant vesicourethral anastomosis (VUA) disruption or postoperative tissue dehiscence in the region of the distal bladder neck that causes a large prolonged urinary leak, perineal pain, and delayed catheter removal. OBJECTIVE To describe our surgical technique using a urinary bladder extracellular matrix (UB-ECM) scaffold incorporated into the base of the VUA and the distal bladder neck during salvage robot-assisted radical prostatectomy (sRARP) and to assess outcomes and safety. DESIGN, SETTING, AND PARTICIPANTS From March to July 2015, 15 patients underwent sRARP performed after primary therapy failure by a single surgeon. Two other groups were identified via analysis of propensity score matching. Group 2 (n=45) underwent sRARP with standard suturing without use of the graft. Group 3 (control group; n=45) underwent primary RARP with no graft placement. These two groups were compared group 1 (n=15), in which patients underwent sRARP and received the scaffold in a 1:3:3 match. SURGICAL PROCEDURE sRARP with use of a UB-ECM scaffold in the posterior aspect of the VUA and distal bladder neck. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Clinical data were prospectively collected in a customized database and retrospectively analyzed. Analysis of variance and Student's t-test were used to test the equality of means for continuous variables, while the χ2 test was used to test categorical variables. RESULTS AND LIMITATIONS There were no anastomotic leaks in the control group, with an average catheter time of 6.3 d (5-7 d). However, a clinically significant VUA/bladder neck disruption was observed in 16 patients (35.5%) in group 2, with a median catheterization time of 17.4 d (9-47 d), while in group 1 only one patient (6.66%) had a significant anastomotic leak on cystography (p=0.045), with median catheterization time of 11.2 d (10-52 d) for this group (p<0.05). CONCLUSIONS Incorporation of a UB-ECM scaffold into the base of the VUA and distal bladder neck should be considered as an option to decrease morbidity associated with sRARP since it decreased the rate of VUA disruption, enhanced healing, and reduced catheterization time. This technique could be a valuable tool for all surgeons performing sRARP. PATIENT SUMMARY We investigated the use of a scaffolding tissue graft when connecting the urethra to the bladder during salvage robot-assisted laparoscopic prostatectomy. This technique was found to be effective and safe.
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Chapin BF. Optimal management of prostate cancer with lethal biology--state-of-the-art local therapy. Asian J Androl 2016; 17:888-91. [PMID: 26178396 PMCID: PMC4814949 DOI: 10.4103/1008-682x.156855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Defining prostate cancer with lethal biology based upon clinical criteria is challenging. Locally advanced/High-Grade prostate cancer can be downstaged or even downgraded with cure in up to 60% of patients with primary therapy.12345 However, what is known is that high-grade prostate cancers have a greater potential for recurrence and progression to metastatic disease, which can ultimately result in a patient's death. Patients with clinical features of “high-risk” prostate cancer (cT2c, PSA >20, ≥ Gl 8 on biopsy) are more likely to harbor more aggressive pathologic findings. The optimal management of high-risk prostate cancer is not known as there are not prospective studies comparing surgery to radiation therapy (RT). Retrospective and population-based studies are subject to many biases and attempts to compare surgery and radiation have demonstrated mixed results. Some show equivalent survival outcomes6 while others showing an advantage of surgery over RT.7891011 Local therapy for high-risk disease does appear to be beneficial. Improved outcomes realized with local therapy have been clearly demonstrated by several prospective studies evaluating androgen deprivation therapy (ADT) alone versus ADT plus RT. The combination of local with systemic treatment showed improved disease-specific and overall survival outcomes.121314 Unfortunately, primary ADT for N0M0 prostate cancer is still inappropriately applied in general practice.11 While the surgical literature is largely retrospective, it too demonstrates that surgery in the setting of high-risk prostate cancer is effective in providing durable disease-specific and overall survivals.2315
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Affiliation(s)
- Brian F Chapin
- University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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35
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The Single-Knot Running Vesicourethral Anastomosis after Minimally Invasive Prostatectomy: Review of the Technique and Its Modifications, Tips, and Pitfalls. Prostate Cancer 2016; 2016:1481727. [PMID: 27340567 PMCID: PMC4906212 DOI: 10.1155/2016/1481727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/12/2016] [Indexed: 12/27/2022] Open
Abstract
The vesicourethral anastomosis represents a step of major difficulty at the end of minimally invasive radical prostatectomy. Over 10 years ago, we have devised the single-knot running vesicourethral anastomosis, which has been widely adopted in urologic departments worldwide. Aim of the current paper is to review the technique, its adaptability in complex situations, its complications, and possible modifications, including the use of barbed sutures.
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37
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Bates A, Samavedi S, Kumar A, Mouraviev V, Rocco B, Coelho R, Palmer K, Patel V. Salvage robot assisted radical prostatectomy: A propensity matched study of perioperative, oncological and functional outcomes. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2015; 41:1540-6. [DOI: 10.1016/j.ejso.2015.06.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 05/10/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
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38
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Sotelo RJ, Haese A, Machuca V, Medina L, Nuñez L, Santinelli F, Hernandez A, Kural AR, Mottrie A, Giedelman C, Mirandolino M, Palmer K, Abaza R, Ghavamian R, Shalhav A, Moinzadeh A, Patel V, Stifelman M, Tuerk I, Canes D. Safer Surgery by Learning from Complications: A Focus on Robotic Prostate Surgery. Eur Urol 2015; 69:334-44. [PMID: 26385157 DOI: 10.1016/j.eururo.2015.08.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND The uptake of robotic surgery has led to changes in potential operative complications, as many surgeons learn minimally invasive surgery, and has allowed the documentation of such complications through the routine collection of intraoperative video. OBJECTIVE We documented intraoperative complications from robot-assisted radical prostatectomy (RARP) with the aim of reporting the mechanisms, etiology, and necessary steps to avoid them. Our goal was to facilitate learning from these complications to improve patient care. DESIGN, SETTING, AND PARTICIPANTS Contributors delivered videos of complications that occurred during laparoscopic and robotic prostatectomy between 2010 and 2015. SURGICAL PROCEDURE Surgical footage was available for a variety of complications during RARP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on these videos, a literature search was performed using relevant terms (prostatectomy, robotic, complications), and the intraoperative steps of the procedures and methods of preventing complications were outlined. RESULTS AND LIMITATIONS As a major surgical procedure, RARP has much potential for intra- and postoperative complications related to patient positioning, access, and the procedure itself. However, with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, we suggest that the majority of such complications are preventable. CONCLUSIONS Considering the complexity of the procedure, RARP is safe and reproducible for the surgical management of prostate cancer. Insight from experienced surgeons may allow surgeons to avoid complications during the learning curve. PATIENT SUMMARY Robot-assisted radical prostatectomy has potential for intra- and postoperative complications, but with a dedicated approach, increasing experience, a low index of suspicion, and strict adherence to safety measures, most complications are preventable.
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Affiliation(s)
- René J Sotelo
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela; University of Southern California, Los Angeles, CA, USA.
| | - Alexander Haese
- Martini Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Victor Machuca
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luis Medina
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | - Luciano Nuñez
- Center of Robotics and Minimally Invasive Surgery, Instituto Médico La Floresta, Caracas, Venezuela
| | | | | | | | | | | | | | | | - Ronney Abaza
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Arieh Shalhav
- Duchossois Center for Advanced Medicine, Chicago, IL, USA
| | - Alireza Moinzadeh
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
| | - Vipul Patel
- Global Robotics Institute, Celebration, FL, USA
| | | | - Ingolf Tuerk
- St. Elizabeth's Medical Center, Brighton, MA, USA
| | - David Canes
- Lahey Hospital and Medical Center Institute of Urology, Burlington, MA, USA
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Agarwal G, Valderrama O, Luchey AM, Pow-Sang JM. Robotic-Assisted Laparoscopic Radical Prostatectomy. Cancer Control 2015; 22:283-90. [DOI: 10.1177/107327481502200305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Gautum Agarwal
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Oscar Valderrama
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Adam M. Luchey
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M. Pow-Sang
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Mandel P, Steuber T, Ahyai S, Kriegmair M, Schiffmann J, Boehm K, Heinzer H, Michl U, Schlomm T, Haese A, Huland H, Graefen M, Tilki D. Salvage radical prostatectomy for recurrent prostate cancer: verification of European Association of Urology guideline criteria. BJU Int 2015; 117:55-61. [DOI: 10.1111/bju.13103] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Mandel
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Steuber
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Ahyai
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | | | - Jonas Schiffmann
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Katharina Boehm
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hans Heinzer
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Uwe Michl
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thorsten Schlomm
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Alexander Haese
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hartwig Huland
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
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41
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Pearce SM, Richards KA, Patel SG, Pariser JJ, Eggener SE. Population-based analysis of salvage radical prostatectomy with examination of factors associated with adverse perioperative outcomes. Urol Oncol 2015; 33:163.e1-6. [PMID: 25708953 DOI: 10.1016/j.urolonc.2015.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Salvage radical prostatectomy (SRP) is a potentially curative operation performed for recurrent prostate cancer after radiation therapy (RT). The purpose of this study was to examine perioperative and pathologic outcomes of SRP in a national cohort. MATERIALS AND METHODS The National Cancer Database from 1998 to 2011 was used to identify 408 patients who underwent SRP. We evaluated the demographic data, clinical variables, and pathologic and perioperative outcomes. Primary outcomes of interest were length of stay (LOS) and positive surgical margins (PSM). A multivariable logistic regression model was employed to identify preoperative predictors of LOS ≥ 3 days and PSM following SRP. RESULTS Among patients undergoing SRP, the mean age was 62.5 ± 6.8 years, mean prostate-specific antigen (PSA) level was 12.6 ± 15.6 ng/ml, and 64% were categorized as clinical stage T1. External beam RT (89%), followed by brachytherapy (11%), was the most common modalities for primary RT. Most SRPs were performed at high-volume centers (57%) in metropolitan locations (83%). Most patients underwent a lymph node dissection (75%) and the mean node count was 15.0 ± 30.1. On final pathology, 73% had intermediate- or high-grade disease (Gleason score 7 in 43% and Gleason score 8-10 in 30%), 49% had pT3 or pT4 disease, 6.2% had positive lymph nodes, and 34% had PSM. The mean LOS was 3.5 ± 9.9 days, and 43% of patients had a LOS ≥ 3 days. The 30-day readmission rate was 6.5% after SRP, and 30- and 90-day postoperative mortality rates were extremely low at 0.4% (n = 1). On multivariable analysis of the entire cohort, PSA level > 20 ng/ml was an independent predictor of PSM (OR = 3.68, 95% CI: 1.2-10.9, P = 0.018). PSA level > 20 ng/ml (OR = 4.37, 95% CI: 1.2-16.2, P = 0.027) and cT2 or greater disease (OR = 2.52, 95% CI: 1.0-6.2, P = 0.046) were associated with prolonged LOS (LOS ≥ 3d), whereas surgery at an academic facility (OR = 0.30, 95% CI: 0.1-0.8, P = 0.02) reduced the odds of LOS ≥ 3 days. CONCLUSIONS In select patients derived from a population-based cohort, SRP results in effective local cancer control with acceptable perioperative outcomes. PSA level > 20 ng/ml is independently associated with PSM and prolonged LOS after SRP. Clinical stage T2 or greater disease is also associated with prolonged LOS, whereas surgery at an academic facility reduced this risk.
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Affiliation(s)
- Shane M Pearce
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL.
| | - Kyle A Richards
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Urology, The University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sanjay G Patel
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Joseph J Pariser
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
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da Silva RD, Fernando J. Focal Cryotherapy in Low-Risk Prostate Cancer: Are We Treating the Cancer or the Mind? - The Cancer. Int Braz J Urol 2015; 41:5-9. [PMID: 25928504 PMCID: PMC4752050 DOI: 10.1590/s1677-5538.ibju.2015.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Affiliation(s)
- Rodrigo Donalisio da Silva
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver CO, USA
| | - J Fernando
- Division of Urology, Department of Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver CO, USA
- University of Colorado Cancer Center, UC Denver. Denver CO, USA
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Abstract
Failure of non-surgical primary treatment for localized prostate cancer is a common occurrence, with rates of disease recurrence ranging from 20% to 60%. In a large proportion of patients, disease recurrence is clinically localized and therefore potentially curable. Unfortunately, due to the complex and potentially morbid nature of salvage treatment, radical salvage surgery is uncommonly performed. In an attempt to decrease the morbidity of salvage therapy without sacrificing oncologic efficacy, a number of experienced centers have utilized robotic assistance to perform minimally invasive salvage radical prostatectomy. Herein, we critically evaluate the existing literature on salvage robotic radical prostatectomy with a focus on patient selection, perioperative complications and functional and early oncologic outcomes. These results are compared with contemporary and historical open salvage radical prostatectomy series and supplemented with insights we have gained from our experience with salvage robotic radical prostatectomy. The body of evidence by which conclusions regarding the efficacy and safety of robotic salvage radical prostatectomy can be drawn comprises fewer than 200 patients with limited follow-up. Preliminary results are promising and some outcomes have been favorable when compared with contemporary open salvage prostatectomy series. Advantages of the robotic platform in the performance of salvage radical prostatectomy include decreased blood loss, short length of stay and improved visualization. Greater experience is required to confirm the long-term oncologic efficacy and functional outcomes as well as the generalizability of results achieved at experienced centers.
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Affiliation(s)
- Samuel D Kaffenberger
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37215, United States
| | - Joseph A Smith
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, TN 37215, United States
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Robotic radical prostatectomy in patients with previous prostate surgery and radiotherapy. Prostate Cancer 2014; 2014:367675. [PMID: 25120933 PMCID: PMC4120925 DOI: 10.1155/2014/367675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 01/22/2023] Open
Abstract
Herein, we will review the available literature about robot-assisted radical prostatectomy in patients who have undergone prostate surgery or radiotherapy. Current data about this topic consists of small case series with limited follow-up. Despite being technically demanding, robot-assisted radical prostatectomy (RARP) can be considered feasible in either setting. Prostate surgery or prostatic irradiation should not be considered as a contraindication for robot-assisted radical prostatectomy. Nevertheless, patient counseling about the possible complications and the need for reintervention is of extreme importance in this patient population. Early oncologic and functional results of RARP performed in case of radiorecurrent prostate cancer look promising. Regarding postprostate surgery RARP, some series have reported comparable results, while some have demonstrated more inferior outcomes than those of naive cases. In order to assess the exact functional and oncologic outcome of RARP in patients with previous prostate surgery and radiotherapy, studies enrolling higher number of patients and providing longer follow-up data are needed.
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