Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy

No AccessJournal of UrologyAdult Urology1 Nov 2017Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy Igor Nunes-Silva, Eric Barret, Victor Srougi, Mohammed Baghdadi, Paolo Capogrosso, Silvia Garcia-Barreras, Solange Kanso, Rafael Tourinho-Barbosa, Ariê Carneiro, Rafael Sanchez-Salas, François Rozet, Marc Galiano, and Xavier Cathelineau Igor Nunes-SilvaIgor Nunes-Silva Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil , Eric BarretEric Barret Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Victor SrougiVictor Srougi Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, University of São Paulo Medical School, São Paulo, Brazil , Mohammed BaghdadiMohammed Baghdadi Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Paolo CapogrossoPaolo Capogrosso Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan, Italy , Silvia Garcia-BarrerasSilvia Garcia-Barreras Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Solange KansoSolange Kanso Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Rafael Tourinho-BarbosaRafael Tourinho-Barbosa Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Ariê CarneiroAriê Carneiro Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Rafael Sanchez-SalasRafael Sanchez-Salas Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , François RozetFrançois Rozet Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , Marc GalianoMarc Galiano Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France , and Xavier CathelineauXavier Cathelineau Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France View All Author Informationhttps://doi.org/10.1016/j.juro.2017.05.071AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We assessed the impact of focal therapy on perioperative, oncologic and functional outcomes in men who underwent salvage robotic assisted radical prostatectomy compared to primary robotic assisted radical prostatectomy. Materials and Methods: Focal therapy was performed in patients presenting with Gleason score 3 + 3 or 3 + 4, clinical stage cT2a or less, serum prostate specific antigen 15 ng/ml or less, unilateral positive biopsy, maximum length of any positive core less than 10 mm and life expectancy greater than 10 years. Focal therapy was defined as target ablation of the index lesion plus a 1 cm safety margin in the normal ipsilateral prostatic parenchyma. The salvage group included 22 men who underwent salvage prostatectomy after focal therapy failure. The primary group was defined using matched pair 1:2 selection of 44 of 2,750 patients treated with primary prostatectomy. The primary and secondary end points were the between group differences in functional and oncologic outcomes, respectively. Results: Complication rates were comparable (p >0.05). Pad-free probability was comparable between the groups at 1 and 2 years (p = 0.8). Recovery of erectile function was significantly lower after salvage robotic assisted radical prostatectomy (p = 0.008), which also showed a significantly lower probability of cumulative biochemical recurrence-free survival compared to primary robotic assisted radical prostatectomy (56.3% vs 92.4% at 2 years, p = 0.001). Salvage prostatectomy demonstrated a significantly increased risk of biochemical recurrence (HR 4.8, 95% CI 1.67–13.76, p = 0.004). Study limitations included the retrospective nature, the lack of randomization and the short followup. Conclusions: Salvage robotic assisted radical prostatectomy after focal therapy failure is feasible with acceptable complication rates. However, patients assigned to primary focal therapy should be advised about a poorer prognosis in terms of oncologic control and lower erectile recovery rates in case of a future salvage surgery. References 1 : Active surveillance for prostate cancer: overview and update. 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Google Scholar © 2017 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCadeddu J (2020) Re: Comparison of Outcomes of Salvage Robot-Assisted Laparoscopic Prostatectomy for Post-Primary Radiation vs Focal TherapyJournal of Urology, VOL. 204, NO. 1, (168-168), Online publication date: 1-Jul-2020.Tourinho-Barbosa R, Sanchez-Salas R, Claros O, Collura-Merlier S, Bakavicius A, Carneiro A, Stabile A, Moschini M, Cathala N, Tobias-Machado M and Cathelineau X (2019) Focal Therapy for Localized Prostate Cancer with Either High Intensity Focused Ultrasound or Cryoablation: A Single Institution ExperienceJournal of Urology, VOL. 203, NO. 2, (320-330), Online publication date: 1-Feb-2020.Thompson J, Sridhar A, Tan W, Freeman A, Haider A, Allen C, Moore C, Orczyk C, Mazzon G, Khetrapal P, Shaw G, Rajan P, Mohammed A, Briggs T, Nathan S, Kelly J and Sooriakumaran P (2019) Pathological Findings and Magnetic Resonance Imaging Concordance at Salvage Radical Prostatectomy for Local Recurrence following Partial Ablation Using High Intensity Focused UltrasoundJournal of Urology, VOL. 201, NO. 6, (1134-1143), Online publication date: 1-Jun-2019.Smith J (2017) This Month in Adult UrologyJournal of Urology, VOL. 198, NO. 5, (951-952), Online publication date: 1-Nov-2017. Volume 198Issue 5November 2017Page: 1069-1076Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordsprostatectomyprostatic neoplasmssurveys and questionnairessalvage therapyrobotic surgical proceduresAcknowledgmentsDrs. Marcos Tobias-Machado and Hamilton Zampolli, Department of Urology, Arnaldo Vieira de Carvalho Cancer Institute-IAVC, São Paulo, Brazil, assisted with the study.MetricsAuthor Information Igor Nunes-Silva Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil More articles by this author Eric Barret Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Victor Srougi Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Department of Urology, University of São Paulo Medical School, São Paulo, Brazil More articles by this author Mohammed Baghdadi Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Paolo Capogrosso Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan, Italy More articles by this author Silvia Garcia-Barreras Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Solange Kanso Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Rafael Tourinho-Barbosa Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Ariê Carneiro Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Rafael Sanchez-Salas Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author François Rozet Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Marc Galiano Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Xavier Cathelineau Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France More articles by this author Expand All Advertisement PDF downloadLoading ...