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Giesen A, Van den Broeck T, Develtere D, Raskin Y, Wymer K, Eden C, Claessens M, Hente R, Rans K, Berghen C, De Meerleer G, Langley S, Karnes RJ, Heidenreich A, Pfister D, Joniau S. Salvage vesiculectomy for local prostate cancer recurrence: surgical technique and early post-operative outcomes. World J Urol 2024; 42:81. [PMID: 38358521 DOI: 10.1007/s00345-024-04771-2] [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: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Isolated recurrence in remnants of the seminal vesicles (SV) after treatment of primary prostate cancer (PCa) has become a more frequent entity with the widespread use of more sensitive next-generation imaging modalities. Salvage vesiculectomy is hypothesized to be a worthwhile management option in these patients. The primary goal of this study is to describe the surgical technique of this new treatment option. Secondary outcomes are peri- and post-operative complications and early oncological outcomes. METHODS Retrospective multicenter study, including 108 patients with solitary recurrence in the SV treated between January 2009 and June 2022, was performed. Patients with local recurrences outside the SVs or with metastatic disease were excluded. Both SVs were resected using a robot-assisted or an open approach. In selected cases, a concomitant lymphadenectomy was performed. RESULTS Overall, 31 patients (29%) reported complications, all but one grade 1 to 3 on the Clavien-Dindo Scale. A median PSA decrease of 2.07 ng/ml (IQR: 0.80-4.33, p < 0.001), translating into a median PSA reduction of 92% (IQR: 59-98%) was observed. At a median follow-up of 14 months, freedom from secondary treatment was 54%. Lymphadenectomy had a significant influence on PSA reduction (p = 0.018). CONCLUSION Salvage vesiculectomy for PCa recurrence limited to the SV is a safe procedure with excellent PSA response and is a potential curative treatment in a subset of patients. A concomitant lymphadenectomy can best be performed in all patients that did not underwent one at primary treatment.
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Affiliation(s)
- Alexander Giesen
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Thomas Van den Broeck
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Dries Develtere
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Yannic Raskin
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Urology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Kevin Wymer
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Christopher Eden
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Robert Hente
- Department of Urology, AZ Klina, Brasschaat, Belgium
| | - Kato Rans
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gert De Meerleer
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Stephen Langley
- Department of Urology, Royal Surrey County Hospital, Guildford, UK
| | | | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany
| | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of Urology, AZ Klina, Brasschaat, Belgium.
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Katelaris DA, Gibson DD, Nalavenkata DS, Thompson DJ. Robotic Salvage Seminal Vesiculectomy for radio-recurrent prostate cancer post LDR brachytherapy following multiple negative trans-perineal biopsies. Urol Case Rep 2022; 43:102064. [PMID: 35368980 PMCID: PMC8967703 DOI: 10.1016/j.eucr.2022.102064] [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] [Received: 02/21/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Multi-parametric Magnetic Resonance Imaging (mp-MRI) and prostate membrane specific antigen positron emission tomography (PSMA-PET) CT scan in prostate cancer has led to enhanced detection of local and metastatic recurrence post-radiotherapy. A 59-year-old man presented with biochemical relapse following low dose rate brachytherapy for ISUP 2 T1cN0M0 prostate cancer (PCa). Despite strong biochemical and radiological evidence of radio-recurrent PCa in his right seminal vesicle, serial transperineal biopsies revealed benign tissue. He proceeded to Robot Assisted Salvage Seminal Vesiculectomy (RSSV) as a diagnostic procedure without complication. Histo-pathology confirmed a 23 × 17 × 13mm focus of Gleason 4 + 4 adenocarcinoma in the SV with clear surgical margins.
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Affiliation(s)
- Dr Athos Katelaris
- Department of Urology, St George Hospital, Sydney, Australia
- The University of New South Wales, Sydney, Australia
- Corresponding author. Department of Urology, St George Hospital, Gray St, Kogarah, 2217, Sydney, Australia.
| | | | - Dr Sunny Nalavenkata
- Department of Urology, St George Hospital, Sydney, Australia
- The University of New South Wales, Sydney, Australia
| | - Dr James Thompson
- Department of Urology, St George Hospital, Sydney, Australia
- The University of New South Wales, Sydney, Australia
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Langley S, Eden C, Perry M, Patil K, Moschonas D, Higgins D, Deering C, Laing R, Perna C, Khaksar S, Uribe-Lewis S, Uribe J. Robot-assisted salvage seminal vesicle excision for isolated recurrence after low-dose-rate prostate brachytherapy. BJU Int 2021; 129:731-736. [PMID: 34460980 DOI: 10.1111/bju.15586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To report clinical and functional outcomes for patients who have undergone salvage robot-assisted seminal vesicle excision (RA-SVE) for the focal treatment of isolated seminal vesical (SV) recurrence after treatment for prostate cancer by low-dose-rate brachytherapy. PATIENTS AND METHODS Patients with rising prostate-specific antigen (PSA) after low-dose-rate prostate brachytherapy (LDR-PB) underwent multi-parametric magnetic resonance imaging (mp-MRI) of the prostate and 11 C-Choline or 68 Ga-prostate-specific membrane antigen (68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) scan, followed by targeted transperineal biopsy of the prostate and SVs. Isolated SV recurrence were identified in 17 (0.38%) LDR-PB patients. These 17 patients were offered RA-SVE. RESULTS The median total operative time was 90 min and blood loss 50 mL with no postoperative transfusions required. The median hospital stay was 1 day. No intra- or postoperative complications were documented. Continence status was unaffected, no patient required urinary pads. Postoperative pathology confirmed SV invasion in all specimens. Surgical margins were positive in seven (41%) patients. All patients had at least one positive imaging study, although three (18%) mp-MRI and five (29%) PET/CT assessments were negative. One (6%) pre-SVE biopsy was also negative but with positive imaging. Salvage SVE failure, defined as three consecutive PSA rises or the need for further treatment, occurred in six patients of whom three had a positive margin. Overall failure-free survival rates were 86%, 67%, and 53% at 1, 2, and 3 years after SVE, respectively. CONCLUSIONS Salvage RA-SVE appears to be a safe focal treatment, with very low morbidity, for patients with localised SV recurrence after LDR-PB. It permits deferral of androgen deprivation therapy in selected patients. Bilateral SVE is mandatory. This surgical option should be considered in patients with isolated prostate cancer recurrence to the SV.
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Affiliation(s)
- Stephen Langley
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Christopher Eden
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Matthew Perry
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Krishna Patil
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Dimitrios Moschonas
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Donna Higgins
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Claire Deering
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Robert Laing
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Carla Perna
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Sara Khaksar
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Santiago Uribe-Lewis
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Jennifer Uribe
- The Stokes Centre for Urology, Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
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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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Pfister D, Hartmann F, Heidenreich A. Re: Sophie Knipper, Luigi Ascalone, Benjamin Ziegler, et al. Salvage Surgery in Patients with Local Recurrence After Radical Prostatectomy. Eur Urol 2021;79:537-44. Eur Urol 2021; 80:e61. [PMID: 34023162 DOI: 10.1016/j.eururo.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022]
Affiliation(s)
- David Pfister
- Department of Urology, Uro-Oncology and Robot-Assisted Surgery, University Hospital of Cologne, Cologne, Germany.
| | - Florian Hartmann
- Department of Urology, Uro-Oncology and Robot-Assisted Surgery, University Hospital of Cologne, Cologne, Germany
| | - Axel Heidenreich
- Department of Urology, Uro-Oncology and Robot-Assisted Surgery, University Hospital of Cologne, Cologne, Germany
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