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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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Nunes-Silva I, Hidaka AK, Glina FPA, Hayashi RM, Glina S. Can salvage Retzius-sparing robotic-assisted radical prostatectomy improve continence outcomes? A systematic review and meta-analysis study. World J Urol 2023; 41:2311-2317. [PMID: 37414943 DOI: 10.1007/s00345-023-04505-w] [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: 05/28/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023] Open
Abstract
PURPOSE Salvage Radical Prostatectomy is challenging and associated with high rates of incontinence. The novel Retzius-sparing RARP (RS-RARP) approach has shown impressive high immediate and 1-year continence rates (> 90%) when applied as primary treatment. The purpose of this study is to evaluate the impact of salvage Retzius-sparing RARP (sRS-RARP) on continence outcomes in the salvage scenario. MATERIALS AND METHODS Using PRISMA guidelines, a systematic review and meta-analysis of articles was conducted on Medline through PubMed and on Cochrane through Central Register of Controlled Trials databases. Inclusion and exclusion criteria were used to select 17 retrospective cohort studies published until April 2023 about sRS-RARP and continence. Data were extracted independently by at least two authors. The International Prospective Register of Systematic Reviews (PROSPERO) was registered. Retrospective studies were subjected to a domain-based risk of bias assessment in accordance with the Newcastle-Ottawa quality assessment scale cohort studies (NOS). Prostate cancer patients were chosen from prospective nonrandomized or randomized sRS-RARP or sS-RARP studies that examined continence outcomes. RESULTS Seventeen studies were included: 14 were retrospectives only and 3 described retrospective comparison cohorts (sRS-RARP vs sS-RARP). All the retrospective studies were of "fair" quality using the NOS. sRS-RARP may increase recovery of urinary continence after surgery compared to sS-RARP [OR 4.36, 95% CI 1.7-11.17; I2 = 46.8%; studies = 4; participants = 87]. CONCLUSIONS sRS-RARP approach has potential to improve continence outcomes in the salvage setting. sRS-RARP approach has potential to positively impact continence function on patients who underwent salvage surgery.
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Affiliation(s)
- Igor Nunes-Silva
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
| | - Alexandre Kyoshi Hidaka
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
| | - Felipe Placco Araujo Glina
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
| | - Renan Murata Hayashi
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil.
| | - Sidney Glina
- Urology Division, Centro Universitário FMABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, 09060-870, Brazil
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Blank F, Meyer M, Wang H, Abbas H, Tayebi S, Hsu WW, Sidana A. Salvage Radical Prostatectomy after Primary Focal Ablative Therapy: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:2727. [PMID: 37345064 DOI: 10.3390/cancers15102727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
CONTEXT Focal therapy (FT) has been gaining popularity as a treatment option for localized intermediate-risk prostate cancer (PCa) due to the associated lower morbidity compared to whole-gland treatment. However, there is an increased risk of local cancer recurrence requiring subsequent treatment in a small proportion of patients. OBJECTIVE To conduct a systematic review and meta-analysis to better describe and analyze patient postoperative, oncologic, and functional outcomes for those who underwent salvage radical prostatectomy (sRP) to manage their primary FT failure. EVIDENCE ACQUISITION A systematic review was completed using three databases (PubMed, Embase, and CINAHL) from October to December 2021 to identify data on outcomes in patients who received sRP for cancer recurrence after prior focal treatment. EVIDENCE SYNTHESIS 12 articles (482 patients) were included. Median time to sRP was 24 months. Median follow-up time was 27 months. A meta-analysis revealed a postoperative complication rate of 15% (95% CI: 0.09, 0.24), with 4.6% meeting criteria for a major complication Clavien (CG) grade ≥3. Severe GU toxicity was seen in 3.6% of the patients, and no patients had severe GI toxicity. Positive surgical margins (PSM) were found in 27% (95% CI: 0.19, 0.37). Biochemical recurrence (BCR) after sRP occurred in 23% (95% CI: 0.17, 0.30), indicating a BCR-free probability of 77% at 2 years. Continence (pad-free) and potency (ability to have penetrative sex) were maintained in 67% (95% CI: 0.53, 0.78) and 37% (95% CI: 0.18, 0.62) at 12 months, respectively. CONCLUSION Our evidence shows acceptable complication rates and oncologic outcomes; however, with suboptimal functional outcomes for patients undergoing sRP for recurrent PCa after prior FT. Inferior outcomes were observed for salvage treatment compared to primary radical prostatectomy (pRP). More high-quality studies are needed to better characterize outcomes after this sequence of PCa treatments. PATIENT SUMMARY We looked at treatment outcomes and toxicity for men treated with sRP for prior FT failure. We conclude that these patients will have significant detriment to genitourinary function, with outcomes being worse than those for pRP patients.
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Affiliation(s)
- Fernando Blank
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Meredith Meyer
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Hannah Wang
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Hasan Abbas
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Shima Tayebi
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Wei-Wen Hsu
- Division of Biostatistics and Bioinformatics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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van Riel LA, Geboers B, Kabaktepe E, Blazevski A, Reesink DJ, Stijns P, Stricker PD, Casanova J, Dominguez‐Escrig JL, de Reijke TM, Scheltema MJ, Oddens JR. Outcomes of salvage radical prostatectomy after initial irreversible electroporation treatment for recurrent prostate cancer. BJU Int 2022; 130:611-618. [PMID: 35474600 PMCID: PMC9790506 DOI: 10.1111/bju.15759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate: (i) safety, (ii) feasibility, and medium-term (iii) oncological and (iv) functional outcomes of salvage radical prostatectomy (sRP) for recurrent localised prostate cancer (PCa) following initial focal therapy using irreversible electroporation (IRE). PATIENTS AND METHODS An international, multicentre and retrospective analysis of prospectively collected data of patients that underwent sRP for recurrent localised PCa after initial primary IRE treatment. Data were reported on (i) surgical complications, (ii) feasibility of sRP reported by surgeons, (iii) time interval between IRE and sRP and pathology results, and (iv) urinary continence, erectile function, and quality of life. RESULTS In four participating centres, a total of 39 patients with a median (interquartile range [IQR]) age 64 (60-67) years were identified. No serious adverse events occurred during or following sRP and surgery was deemed feasible without difficulties. The median (IQR) time to recurrence following IRE was 14.3 (9.1-38.8) months. Pathology results showed localised disease in 21 patients (53.8%) and locally-advanced disease in 18 (46.2%). Positive surgical margins (PSMs) were observed in 10 patients (25.6%), of which six (15.4%) had significant PSMs. A persistent detectable prostate-specific antigen level was found in one case after sRP, caused by metastatic disease. One patient had a biochemical recurrence 6 months after sRP. These two cases, together with a PSM case, required additional therapy after sRP. After a median (IQR) follow-up of 17.7 (11.8-26.4) months, urinary continence and erectile function were preserved in 34 (94.4%) and 18 patients (52.9%), respectively, while quality of life remained stable. CONCLUSIONS Salvage RP is safe and feasible for patients with recurrent localised PCa following initial IRE treatment. The medium-term oncological and functional outcomes are similar to primary RP. Strict patient selection for focal therapy and standardised follow-up is needed as some patients developed high-grade disease.
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Affiliation(s)
- Luigi A.M.J.G. van Riel
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Bart Geboers
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands,Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Ertunc Kabaktepe
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Alexander Blazevski
- Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Daan J. Reesink
- Department of UrologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Pascal Stijns
- St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Phillip D. Stricker
- Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,Department of UrologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Juan Casanova
- Department of UrologyInstituto Valenciano de OncologiaValènciaSpain
| | | | - Theo M. de Reijke
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Matthijs J. Scheltema
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands,Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Jorg R. Oddens
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
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Bhat KRS, Covas Moschovas M, Sandri M, Noel J, Reddy S, Perera R, Rogers T, Roof S, Patel VR. Outcomes of Salvage Robot-assisted Radical Prostatectomy After Focal Ablation for Prostate Cancer in Comparison to Primary Robot-assisted Radical Prostatectomy: A Matched Analysis. Eur Urol Focus 2022; 8:1192-1197. [PMID: 34736871 DOI: 10.1016/j.euf.2021.10.005] [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: 06/14/2021] [Revised: 09/08/2021] [Accepted: 10/05/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND Focal therapy (FT) for prostate cancer is less invasive than radical treatment but carries a risk of recurrence. Salvage robot-assisted radical prostatectomy (S-RARP) is a possible option after FT failure. OBJECTIVE To evaluate the impact of FT on functional and oncological outcomes following S-RARP. DESIGN, SETTING, AND PARTICIPANTS In a retrospective analysis of data from a prospectively collected institutional database, 53 patients who underwent S-RARP following failure of focal ablation were selected as group I; patients who had whole-gland ablation and external beam therapy were excluded. This group was matched to a control sample (matched at ratios of 1:1, 1:2, 1:3, 1:4) of men who had undergone primary RARP, using age, prostate-specific antigen (PSA), PSA density, body mass index, Sexual Health Inventory for Men score, American Urological Association symptom score, Charlson comorbidity index, prostate weight, preoperative Gleason score (GS), and history of smoking as variables. SURGICAL PROCEDURE S-RARP after FT was performed using a standardized technique developed at our institute with the da Vinci Xi Surgical System. MEASUREMENTS Oncological and functional outcomes were compared between the S-RARP and primary RARP groups. RESULTS AND LIMITATIONS There was no difference in estimated blood loss (p = 0.8) between the 1:1 matched groups, but operating room time was significantly longer for S-RARP (p = 0.007). The primary RARP group had a higher proportion of patients who underwent a full nerve-sparing procedure. The S-RARP group had higher incidence of positive surgical margins (40% vs 15%; p = 0.008), GS ≥8 (25% vs 15%; p = 0.07), and positive lymph node status (9.4% vs 5.7%; p = 0.02). There was no significant difference in overall complications between the groups. The primary RARP group had a higher incidence of lymphocele drainage after surgery (15% vs 0%; p = 0.006). The main limitation of the study is its retrospective design. CONCLUSIONS S-RALP after FT failure is feasible; however, surgery following FT leads to poorer oncological and functional outcomes. Despite the targeted nature of FT, significant nonfocal collateral damage is evident in tissues surrounding the prostate, which in turn translates to poorer functional outcomes after S-RARP. PATIENT SUMMARY We studied the surgical challenges during robot-assisted removal of the prostate after previous focal treatment (FT) for prostate cancer and compared the outcomes to those for robot-assisted prostate removal in patients who had no previous FT. We found that this technique is safe and effective with a limited risk of complications, but poor urinary and sexual functional outcomes.
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Affiliation(s)
| | | | - Marco Sandri
- Data Methods and Systems Statistical Laboratory, University of Brescia, Brescia, Italy
| | - Jonathan Noel
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | - Sunil Reddy
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | | | - Travis Rogers
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | - Shannon Roof
- Global Robotics Institute, Advent Health, Celebration, FL, USA
| | - Vipul R Patel
- Global Robotics Institute, Advent Health, Celebration, FL, USA
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Applications of Focused Ultrasound in the Treatment of Genitourinary Cancers. Cancers (Basel) 2022; 14:cancers14061536. [PMID: 35326687 PMCID: PMC8945954 DOI: 10.3390/cancers14061536] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Cancer is a prevalent disease globally, and conventional treatment options have been associated with substantial morbidity for patients. The unique acoustic properties and biological effects of focused ultrasound have been investigated for use as an alternative treatment option for various forms of cancer with lower associated morbidity than standard treatments. The objective of our review was to assess the current state and various applications of focused ultrasound for the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular malignancies. Current research demonstrates that focused ultrasound-based focal therapy shows promise for the treatment of localized prostate and kidney cancer, and the effect of ultrasound on cell membranes may increase the efficacy of chemotherapeutics and radiotherapy. Focused ultrasound-based treatment modalities should continue to be investigated as an alternative or complementary treatment option for cancer patients. Abstract Traditional cancer treatments have been associated with substantial morbidity for patients. Focused ultrasound offers a novel modality for the treatment of various forms of cancer which may offer effective oncological control and low morbidity. We performed a review of PubMed articles assessing the current applications of focused ultrasound in the treatment of genitourinary cancers, including prostate, kidney, bladder, penile, and testicular cancer. Current research indicates that high-intensity focused ultrasound (HIFU) focal therapy offers effective short-term oncologic control of localized prostate and kidney cancer with lower associated morbidity than radical surgery. In addition, studies in mice have demonstrated that focused ultrasound treatment increases the accuracy of chemotherapeutic drug delivery, the efficacy of drug uptake, and cytotoxic effects within targeted cancer cells. Ultrasound-based therapy shows promise for the treatment of genitourinary cancers. Further research should continue to investigate focused ultrasound as an alternative cancer treatment option or as a complement to increase the efficacy of conventional treatments such as chemotherapy and radiotherapy.
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Blazevski A, Gondoputro W, Scheltema MJ, Amin A, Geboers B, Barreto D, Haynes AM, Shnier R, Delprado W, Agrawal S, Thompson JE, Stricker PD. Salvage robot-assisted radical prostatectomy following focal ablation with irreversible electroporation: feasibility, oncological and functional outcomes. BMC Urol 2022; 22:28. [PMID: 35236338 PMCID: PMC8892750 DOI: 10.1186/s12894-022-00978-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background To report the feasibility, oncological and functional outcomes of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer (PCa) after irreversible electroporation (IRE). Methods This was a retrospective analysis of patients who underwent sRARP by a single high-volume surgeon after IRE treatment in our institution. Surgical complications, oncological and functional outcomes were assessed. Results 15 patients with at least 12 months follow up were identified out of the 234 men who underwent primary IRE between 2013 and 2019. The median [IQR] age was 68 (62–70) years. The median [IQR] time from focal IRE to sRARP was 42 (21–57) months. There were no rectal, bladder or ureteric injuries. The T-stage was pT2 in 9 (60%) patients and pT3a in 6 (40%) patients. Only one (7%) patient had a positive surgical margin. At a median [IQR] follow up of 22 (16–32) months no patient had a biochemical recurrence (PSA > 0.2). All 15 patients were continent (pad-free) by 6 months and 9 (60%) patients had erections sufficient for intercourse with or without PDE5 inhibitors. No predisposing factors were identified for predicting erectile dysfunction after sRARP. Conclusions In patients with recurrent or residual significant PCa after focal IRE ablation it is feasible to obtain good functional and oncological outcomes with sRARP. Our results demonstrate that good outcomes can be achieved with sRARP, when respecting close monitoring post-IRE, good patient selection and surgical experience. The limitations of this study are that it is a small series, with short follow up and a lack of standardised quality of life instruments. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-00978-w.
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Affiliation(s)
- Alexandar Blazevski
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia. .,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia. .,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia.
| | - William Gondoputro
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Matthijs J Scheltema
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,Department of Urology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Amer Amin
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Bart Geboers
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,Department of Interventional Radiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Daniela Barreto
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Anne-Maree Haynes
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | | | - Warick Delprado
- Douglas Hanly Moir Pathology, Macquarie Park, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - James E Thompson
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Phillip D Stricker
- St. Vincent's Prostate Cancer Research Centre, Darlinghurst, NSW, Australia.,Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia.,St. Vincent's Clinical School, University of New South Wales, Sydney, Australia
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8
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Spitznagel T, Hardenberg JV, Schmid FA, Rupp NJ, Westhoff N, Worst TS, Weis CA, Mortezavi A, Eberli D. Salvage Robotic-assisted Laparoscopic Radical Prostatectomy Following Focal High-Intensity Focused Ultrasound for ISUP 2/3 Cancer. Urology 2021; 156:147-153. [PMID: 34186136 DOI: 10.1016/j.urology.2021.04.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/14/2021] [Accepted: 04/18/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To report feasibility and outcome of salvage robotic-assisted laparoscopic radical prostatectomy (S-RALP) after focal therapy using high-intensity focused ultrasound (HIFU) treatment compared to primary robotic-assisted laparoscopic radical prostatectomy (pRALP). METHODS In this bicentric trial patients undergoing S-RALP for detection of WHO2016/ISUP Grade Group 2 or 3 prostate cancer were previously treated in prospective focal HIFU trials. Perioperative data, complications, oncological and functional outcome were analysed. Patients who underwent pRALP were matched in a ratio 2(pRALP):1(S-RALP) according to preoperatively functional, oncological and clinical parameters. RESULTS A total of 39 patients were included in the study (13S-RALP, 26pRALP). Median operative time in the S-RALP group was 260minutes (pRALP: 257minutes), blood loss was 230ml (pRALP: 300ml). Complications occurred in 46.2% (6/13) of S-RALP patients (pRALP: 26.9%), including four Clavien-Dindo III complications (pRALP: 2/26). In S-RALP adverse histological outcome (≥pT3a, pN+ or R1) was detected in 23.1% (3/13) (pRALP: 26.9%). There was one patient with PSA-persistence (pRALP: 2/26). Regarding functional outcomes there was no difference between the two groups observed (incontinence P=.71, erectile function P=.21). CONCLUSION S-RALP should be offered to patients with an early relapse after focal HIFU. The early oncological outcome is satisfactory and functional outcome one year postoperatively is similar to pRALP. However, S-RALP is associated with a higher rate of Clavien-Dindo III complications (mainly, placement of a drainage), of which patients should be informed beforehand.
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Affiliation(s)
- T Spitznagel
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J V Hardenberg
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - F A Schmid
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N J Rupp
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - N Westhoff
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - T S Worst
- Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Cleo-A Weis
- Institute of Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - A Mortezavi
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - D Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Nunes-Silva I, Hidaka AK, Monti CR, Tobias-Machado M, Zampolli HC. Salvage Retzius sparing robotic assisted radical prostatectomy: the first brazilian experience. Int Braz J Urol 2021; 47:1279-1280. [PMID: 34156193 PMCID: PMC8486463 DOI: 10.1590/s1677-5538.ibju.2021.0260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: Salvage Radical Prostatectomy after radiation therapy is challenging and associated with high rates of serious complications (1, 2). The novel Retzius-Sparing RARP (RS-RARP) approach has shown excellent continence outcomes (3, 4). Purpose: To describe step-by-step our Salvage Retzius-Sparing RARP (sRS-RARP) operative technique and report feasibility, safety and the preliminary oncological and continence outcomes in the post-radiation scenario. Materials and Methods: Twelve males presenting local prostate cancer recurrence after radiotherapy that underwent sRS-RARP were included. All patients performed preoperative multiparametric MRI and PSMA-PET. Surgical technique: 7cm peritoneum opening at Douglas pouch, Recto-prostatic space development, Seminal vesicles and vas deferens isolation and section, Extra-fascial dissection through peri-prostatic fat, Neurovascular bundle control, Bladder neck total preservation and opening, Anterior dissection at Santorini plexus plane, Apex dissection with urethra preservation and section, Prostate release, Vesicouretral modified Van Velthoveen anastomosis, Rocco Stitch, Oncological and continence outcomes reported with minimum 1-year follow-up. Results: Ten patients had previously received external beam radiation (EBR) whereas two received previous brachytherapy plus EBR. At 1, 3 and 12 months after surgery, 25%, 75% and 91.6% of the men used one safety pad or less, respectively. No major complications or blood transfusions were reported. Final pathology reported pT2b 41.6%, pT2c 33.3% and pT3a 25%, positive surgical margins 25%, positive lymph nodes were not found, biochemical recurrence 16.6%. Conclusion: Salvage Retzius-Sparing Robotic Assisted Radical Prostatectomy approach appears to be technically feasible and oncologically safe with potential to provide better continence outcomes.
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Affiliation(s)
- Igor Nunes-Silva
- Instituto do Câncer Dr. Arnaldo Vieira de Carvalho - IAVC, São Paulo, SP, Brasil.,IN Cancer Center, São Paulo, SP, Brasil.,Instituto de Radium Oncology, Campinas, SP, Brasil.,Clinica Onco Hematos, Aracaju, SE, Brasil
| | - Alexandre Kyoshi Hidaka
- Instituto do Câncer Dr. Arnaldo Vieira de Carvalho - IAVC, São Paulo, SP, Brasil.,Divisão de Urologia, Faculdade de Medicina do ABC - FMABC, Santo André, SP, Brasil
| | - Carlos Roberto Monti
- Instituto de Radium Oncology, Campinas, SP, Brasil.,Divisão de Urologia, Faculdade de Medicina, Pontifícia Universidade Católica de Campinas - PUC-Campinas, Campinas, SP, Brasil
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10
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre. EUR UROL SUPPL 2021; 27:43-52. [PMID: 33997823 PMCID: PMC8090976 DOI: 10.1016/j.euros.2021.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Salvage robot-assisted radical prostatectomy (sRARP) is a potential treatment option for locally recurrent prostate cancer (PCa) after nonsurgical primary treatment. There are minimal data comparing outcomes between propensity-matched sRARP and primary robot-assisted radical prostatectomy (RARP). Objective The primary objective is to compare perioperative, oncological, and functional outcomes of sRARP with primary RARP, and the secondary is to compare outcomes between sRARP after whole and focal gland therapy. Design, setting, and participants A 1:1 propensity-matched comparison was carried out of 135 sRARP cases with primary RARP cases from a cohort of 3852 consecutive patients from a high-volume tertiary centre. Outcome measurements and statistical analysis Perioperative, oncological, and functional outcomes including complication rates, positive surgical margins, biochemical recurrence (BCR), continence, and erectile dysfunction (ED) were retrospectively collected. Results and limitations There were no significant differences in patient characteristics between sRARP and primary RARP groups. In the salvage and primary groups, median (interquartile range) follow-up periods were 521 (304–951) and 638 (394–951) d, grade III–V Clavien-Dindo complication rates were 1.5% and 0% (p = 0.310), BCR rates were 31.9% and 14.1% (p < 0.001) at the last follow-up, pad-free continence rates were 78.8% and 84.3% at 2 yr (p = 0.337), and ED rates were 94.8% and 76.3% (p < 0.001), respectively. Comparing the whole and focal gland groups, BCR rates were 36.7% and 29.1% (p = 0.687) at follow-up, pad-free continence rates were 53.1% and 89.3% at 2 yr (p < 0.001), and ED rates were 98% and 93% (p = 0.214), respectively. Conclusions Salvage RARP has similar perioperative outcomes to primary RARP with inferior potency rates. Post–focal therapy sRARP has similar recurrence and continence rates to primary RARP. Post–whole gland therapy, complication, and recurrence rates are higher, and there is a higher risk of urinary incontinence. Patient summary We report the largest propensity-matched comparison of salvage robot-assisted radical prostatectomy (RARP) after focal and whole gland therapy. Salvage RARP is a feasible procedure for the treatment of locally recurrent prostate cancer in high-volume centres; however, patients should be counselled appropriately as to the different outcomes.
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Affiliation(s)
- Arjun Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | | | - Ruben De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - Amandeep Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | | | | | | | - Veeru Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ashwin Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Prabhakar Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, UK
| | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Senthil Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
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11
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Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer. World J Urol 2021; 39:3747-3754. [PMID: 33881557 PMCID: PMC8519844 DOI: 10.1007/s00345-021-03700-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/10/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Due to the tissue preserving approach of focal therapy (FT), local cancer relapse can occur. Uncertainty exists regarding triggers and outcome of salvage strategies. METHODS Patients with biopsy-proven prostate cancer (PCa) after FT for localized PCa from 2011 to 2020 at eight tertiary referral hospitals in Germany that underwent salvage radical prostatectomy (S-RP), salvage radiotherapy (S-RT) or active surveillance (AS) were reported. Prostate specific antigen (PSA) changes, suspicious lesions on mpMRI and histopathological findings on biopsy were analyzed. A multivariable regression model was created for adverse pathological findings (APF) at S-RP specimen. Kaplan-Meier curves were generated to determine oncological outcomes. RESULTS A total of 90 men were included. Cancer relapse after FT was detected at a median of 12 months (IQR 9-16). Of 50 men initially under AS 13 received S-RP or S-RT. In total, 44 men underwent S-RP and 13 S-RT. At cancer relapse 17 men (38.6%) in the S-RP group [S-RT n = 4 (30.8%); AS n = 3 (6%)] had ISUP > 2. APF (pT ≥ 3, ISUP ≥ 3, pN + or R1) were observed in 23 men (52.3%). A higher ISUP on biopsy was associated with APF [p = 0.006 (HR 2.32, 97.5% CI 1.35-4.59)] on univariable analysis. Progression-free survival was 80.4% after S-RP and 100% after S-RT at 3 years. Secondary therapy-free survival was 41.7% at 3 years in men undergoing AS. Metastasis-free survival was 80% at 5 years for the whole cohort. CONCLUSION With early detection of cancer relapse after FT S-RP and S-RT provide sufficient oncologic control at short to intermediate follow-up. After AS, a high secondary-therapy rate was observed.
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12
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Ta MH, Nunes-Silva I, Barret E, Renard-Penna R, Rozet F, Mombet A, Cathala N, Sanchez-Salas R, Créhange G, Cathelineau X, Cosset JM. Focal Brachytherapy for Localized Prostate Cancer: Midterm Outcomes. Pract Radiat Oncol 2021; 11:e477-e485. [PMID: 33422681 DOI: 10.1016/j.prro.2020.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Focal brachytherapy (F-BT) is a suitable technique for focal therapy in localized prostate cancer. It has the ability to adapt the seed implantation to the volume and location of the tumor. The aim of this study was to assess F-BT oncologic, functional, and toxicity midterm outcomes in men who underwent prostate cancer treatment. METHODS AND MATERIALS The study included 39 men with low- to intermediate-risk prostate cancer treated with F-BT between 2010 and 2015. The dose prescription was 145 Gy. Failure was defined as the presence of any residual prostate cancer in the treated area. The primary and secondary endpoints were the F-BT oncologic and functional outcomes, respectively. A 2-sided P value < .05 indicated statistical significance. RESULTS The mean follow-up time was 65 months (range, 43-104 months). After 24 months, 34 patients underwent control biopsies and 5 patients refused. The biopsies were negative in 27 cases (79%) and positive in 7 cases (21%), all outside the volume treated. Biochemical relapse-free survival at 5 years, disease-free survival, and overall survival were 96.8% ± 0.032%, 79.5% ± 0.076%, and 100%, respectively. The mean International Prostate Symptom Score at 2 months was significantly higher than initially (P = .0003), with no significant difference later. No late urinary, sexual, or rectal toxicity was observed. Salvage treatment was possible with good tolerance at 3.4 years of follow-up. Limitations of this study include the retrospective nature and lack of randomization. CONCLUSIONS F-BT is a safe and effective treatment for selected patients presenting with low- or intermediate-risk localized prostate cancer.
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Affiliation(s)
- Minh-Hanh Ta
- Radiotherapy Department, SNC Charlebourg, Amethyst Group, La Garenne-Colombes, France
| | - Igor Nunes-Silva
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Urology Department, Arnaldo Vieira de Carvalho Cancer Institute, Sao Paulo, Brazil
| | - Eric Barret
- Urology Department, Institut Mutualiste Montsouris, Paris, France.
| | | | - François Rozet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Annick Mombet
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | - Nathalie Cathala
- Urology Department, Institut Mutualiste Montsouris, Paris, France
| | | | - Gilles Créhange
- Urology Department, Institut Mutualiste Montsouris, Paris, France; Oncology/Radiotherapy Department, Institut Curie, Paris, France
| | | | - Jean-Marc Cosset
- Radiotherapy Department, SNC Charlebourg, Amethyst Group, La Garenne-Colombes, France; Urology Department, Institut Mutualiste Montsouris, Paris, France; Oncology/Radiotherapy Department, Institut Curie, Paris, France
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13
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Making a case "for" focal therapy of the prostate in intermediate risk prostate cancer: current perspective and ongoing trials. World J Urol 2021; 39:729-739. [PMID: 33388878 DOI: 10.1007/s00345-020-03525-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/09/2020] [Indexed: 01/08/2023] Open
Abstract
Focal therapy is growing as an alternative management options for men with clinically localized prostate cancer. Parallel to the increasing popularity of active surveillance (AS) as a treatment for low-risk disease, there has been an increased interest towards providing focal therapy for patients with intermediate-risk disease. Focal therapy can act as a logical "middle ground" in patients who seek treatment while minimizing potential side effects of definitive whole-gland treatment. The aim of the current review is to define the rationale of focal therapy in patients with intermediate-risk prostate cancer and highlight the importance of patient selection in focal therapy candidacy.
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14
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Reddy D, Bedi N, Dudderidge T. Focal therapy, time to join the multi-disciplinary team discussion? Transl Androl Urol 2020; 9:1526-1534. [PMID: 32676440 PMCID: PMC7354327 DOI: 10.21037/tau.2019.09.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Organ preserving management is common place in renal cancer, breast cancer and many other solid organ tumours. Current strategies in managing intermediate risk prostate cancer include either whole gland treatment, in the form of radical radiotherapy or radical prostatectomy, or active surveillance. The former is associated with significant post-treatment functional morbidity, whilst the latter associated with the burden of surveillance activity and patient anxiety. Focal therapy would logically fit as a middle ground for suitable patients in whom treatment would be recommended, but where much better functional outcomes may be possible. Ideally this comes without restricting the successful prevention of harm from the cancer. Historically limitations in developing tissue preserving focal therapy strategies in prostate cancer, were due to inaccuracies in tumour characterisation prior to treatment and during follow up. Consequently for example many patients undergoing an active surveillance strategy were being upgraded and upstaged within a short period. Recently high level evidence supporting the use of MRI and targeted biopsies, in particular the PROMIS and PRECISION trials have strengthened clinician confidence in accurate disease characterisation, thus making focal therapy to become a more feasible management option. With improved diagnostic strategies and the publication of reassuring medium term oncological and functional outcomes after focal therapy for intermediate risk prostate cancer, has the time come to require consideration of focal therapy within our multi-disciplinary team (MDT) meetings and with patients? In this review we will consider patient selection and the evidence for the various focal ablation options as well as the surveillance of these patients after treatment. The forthcoming trials to determine comparative effectiveness will be discussed.
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Affiliation(s)
- Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Nishant Bedi
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, Southampton General Hospital, University Hospital Southampton NHS Trust, Southampton, UK
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15
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Thompson JE, Sridhar AN, Shaw G, Rajan P, Mohammed A, Briggs TP, Nathan S, Kelly JD, Sooriakumaran P. Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation. BMC Urol 2020; 20:81. [PMID: 32611411 PMCID: PMC7329479 DOI: 10.1186/s12894-020-00656-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and oncologic outcomes of sRARP.. The objective of this study was therefore to describe peri-operative safety, functional and early oncologic outcomes following salvage robot-assisted radical prostatectomy (sRARP) for local recurrence after HIFU-PA. METHODS Retrospective analysis of a prospective database of 53 consecutive men who underwent sRARP after HIFU-PA from 2012 to 2018. Continence and erectile-function were reported pre-HIFU, pre-sRARP, 3-months post-sRARP and 12-months post-sRARP. Complications, PSMs and need for subsequent ADT/radiotherapy were assessed. RESULTS 45 men were suitable for inclusion and had sufficient data for analyses. Median duration from HIFU to sRARP was 30.0 months and median follow-up post-sRARP was 17.7 months. Median age, PSA and ISUP group were 63.0 yrs., 7.2 ng/mL and 2; 88.9% were cT2. Median operative-console time, blood loss and hospital stay were 140 min, 200 ml and 1 day respectively. Clavien-Dindo grade 1, 2 and 3 complications < 90 days occurred in 8.9, 6.7 and 2.2%; late (>90d) complications occurred in 13.2%. At sRARP pathology, ISUP 3-5 occurred in 51.1%, pT3a/b in 64.5%, and PSMs in 44.4% (37.5% for pT2, 48.3% for pT3). Of men with > 3-months follow-up after sRARP, 26.3% underwent adjuvant radiotherapy/ADT for residual disease or adverse pathologic features; 5.3% experienced BCR requiring salvage ADT/radiotherapy. Freedom from ADT/radiotherapy was 66.7% at 12-months. Pad-free rates were 100% pre-HIFU, 95.3% post-HIFU, 29.4% 3-months post-sRARP, and 65.5% 12-months post-sRARP. Median IIEF-5 scores pre-HIFU, post-HIFU, 3- and 12-months post-sRARP were 23.5, 16, 5 and 5, respectively. Potency rates were 81.8, 65.5, 0 and 0%, respectively. Bilateral/unilateral nerve sparing were feasible in 7%/22%. CONCLUSION Salvage RARP was safe with acceptable but sub-optimal continence and poor sexual-function and poor oncologic outcomes. One in three men required additional treatment within 12-months. This information may aid men and urologists with treatment selection and counselling regarding primary HIFU-PA vs primary RARP and when considering salvage RARP.
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Affiliation(s)
- James E Thompson
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. .,Faculty of Medicine, University of New South Wales, Kensington, Australia.
| | - Ashwin N Sridhar
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.,Division of Surgery & Interventional Sciences, University College London, London, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.,Division of Surgery & Interventional Sciences, University College London, London, UK
| | - Prabhakar Rajan
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.,Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Anna Mohammed
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK
| | - Timothy P Briggs
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK
| | - Senthil Nathan
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.,Division of Surgery & Interventional Sciences, University College London, London, UK
| | - John D Kelly
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.,Division of Surgery & Interventional Sciences, University College London, London, UK
| | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.,Division of Surgery & Interventional Sciences, University College London, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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16
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Stonier T, Cathcart P. Further evidence that surgery after focal therapy for prostate cancer is safe. BJU Int 2020; 125:481-482. [PMID: 32250051 DOI: 10.1111/bju.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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17
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Herrera-Caceres JO, Nason GJ, Salgado-Sanmamed N, Goldberg H, Woon DTS, Chandrasekar T, Ajib K, Tan GH, Alhunaidi O, van der Kwast T, Finelli A, Zlotta AR, Hamilton RJ, Berlin A, Perlis N, Fleshner NE. Salvage radical prostatectomy following focal therapy: functional and oncological outcomes. BJU Int 2020; 125:525-530. [PMID: 31863617 DOI: 10.1111/bju.14976] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To report the oncological and functional outcomes of salvage radical prostatectomy (sRP) after focal therapy (FT). PATIENTS AND METHODS A retrospective review of all patients who underwent sRP after FT was performed. Clinical and pathological outcomes focussed on surgical complications, oncological, and functional outcomes. RESULTS In all, 34 patients were identified. The median (interquartile range [IQR]) age was 61 (8.25) years. FT modalities included high-intensity focussed ultrasound (19 patients), laser ablation (13), focal brachytherapy (one) and cryotherapy (one). The median (IQR) time from FT to recurrence was 10.9 (17.6) months. There were no rectal or ureteric injuries. Two (5.9%) patients had iatrogenic cystotomies and four (11.8%) developed bladder neck contractures. The mean (sd) hospital stay was 2.5 (2.1) days. The T-stage was pT2 in 14 (41.2%) patients, pT3a in 16 (47.1%), and pT3b in four (11.8%). In all, 13 (38%) patients had positive surgical margins (PSMs). Six (17.6%) patients received adjuvant radiotherapy (RT). At a mean follow-up of 4.3 years, seven (20.6%) patients developed biochemical recurrence (BCR), and of these, six (17.6%) patients required salvage RT. PSMs were associated with worse BCR-free survival (hazard ratio 6.624, 95% confidence interval 2.243-19.563; P < 0.001). The median (IQR) preoperative International Prostate Symptom Score and International Index of Erectile Function score was 7 (4.5-9.5) and 23.5 (15.75-25) respectively, while in the final follow-up the median (IQR) values were 7 (3.5-11) and 6 (5-12.25), respectively (P = 0.088 and P < 0.001). At last follow-up, 31 (91.2%) patients were continent, two (5.9%) had moderate (>1 pad/day) incontinence, and one (2.9%) required an artificial urinary sphincter. CONCLUSIONS sRP should be considered as an option for patients who have persistent clinically significant prostate cancer or recurrence after FT. PSMs should be recognised as a risk for recurrent disease after sRP.
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Affiliation(s)
- Jaime O Herrera-Caceres
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gregory J Nason
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Noelia Salgado-Sanmamed
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hanan Goldberg
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dixon T S Woon
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thenappen Chandrasekar
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Omar Alhunaidi
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Theodorus van der Kwast
- Department of Pathology and Laboratory Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Neil E Fleshner
- Division of Urology, Department of Surgical Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
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18
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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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Stabile A, Orczyk C, Hosking-Jervis F, Giganti F, Arya M, Hindley RG, Dickinson L, Allen C, Punwani S, Jameson C, Freeman A, McCartan N, Montorsi F, Briganti A, Ahmed HU, Emberton M, Moore CM. Medium-term oncological outcomes in a large cohort of men treated with either focal or hemi-ablation using high-intensity focused ultrasonography for primary localized prostate cancer. BJU Int 2019; 124:431-440. [PMID: 30753756 DOI: 10.1111/bju.14710] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To report medium-term oncological outcomes in men receiving primary focal treatment with high-intensity focused ultrasonography ( HIFU) for prostate cancer (PCa). PATIENTS AND METHODS Consecutive patients with PCa treated with primary focal HIFU at two centres by six treating clinicians were assessed. Patients were submitted to either focal ablation or hemi-ablation using HIFU (Sonablate 500). The primary objective of the study was to assess medium-term oncological outcomes, defined as overall survival, freedom from biopsy failure, freedom from any further treatment and freedom from radical treatment after focal HIFU. The secondary objective was to evaluate the changes in pathological features among patients treated with focal HIFU over time. We also assessed the relationship between year of surgery and 5-year retreatment probability. RESULTS A total of 1032 men treated between November 2005 and October 2017 were assessed. The median age was 65 years and median prostate-specific antigen level was 7 ng/mL. The majority of patients had a Gleason score of 3 + 4 or above (80.3%). The median (interquartile range) follow-up was 36 (14-64) months. The overall survival rates at 24, 60 and 96 months were 99%, 97% and 97%, respectively. Freedom from biopsy failure, defined as absence of Gleason 3 + 4 disease, was 84%, 64% and 54% at 24, 60 and 96 months. Freedom from any further treatment was 85%, 59% and 46% at 24, 60 and 96 months, respectively. Approximately 70% of patients who were retreated received a second focal treatment. Freedom from radical treatment was 98%, 91% and 81% at 24, 60 and 96 months. During the study period, we observed an increase in the proportion of patients undergoing focal HIFU with Gleason 3 + 4 disease and with T2 stage disease as defined by multiparametric magnetic resonance imaging. Finally, there was a reduction over time in the proportion of patients undergoing re-treatment within 5 years of first treatment. CONCLUSIONS Focal HIFU for PCa is a feasible therapeutic strategy, with acceptable survival and oncological results and a reduction in the 5-year retreatment rates over the last decade. Re-do focal treatment is a feasible technique whose functional and oncological outcomes have still to be evaluated.
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Affiliation(s)
- Armando Stabile
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Clement Orczyk
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Francesco Giganti
- Division of Surgery and Interventional Science, University College London, London, UK
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Manit Arya
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Richard G Hindley
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Louise Dickinson
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Clare Allen
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shonit Punwani
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles Jameson
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil McCartan
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Caroline M Moore
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
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20
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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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21
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Marconi L, Stonier T, Tourinho-Barbosa R, Moore C, Ahmed HU, Cathelineau X, Emberton M, Sanchez-Salas R, Cathcart P. Robot-assisted Radical Prostatectomy After Focal Therapy: Oncological, Functional Outcomes and Predictors of Recurrence. Eur Urol 2019; 76:27-30. [DOI: 10.1016/j.eururo.2019.03.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/04/2019] [Indexed: 12/17/2022]
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22
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King MT, Nguyen PL, Boldbaatar N, Yang DD, Muralidhar V, Tempany CM, Cormack RA, Hurwitz MD, Suh WW, Pomerantz MM, D'Amico AV, Orio PF. Evaluating the influence of prostate-specific antigen kinetics on metastasis in men with PSA recurrence after partial gland therapy. Brachytherapy 2019; 18:198-203. [DOI: 10.1016/j.brachy.2018.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
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Abstract
Focal therapy (FT) should have the same oncological efficacy as whole gland therapy with fewer side effects. Precise diagnosis with PI-RADS v2 standard multiparametric magnetic resonance imaging (MRI) and fusion or template biopsy is a basic prerequisite. Numerous ablation technologies and treatment strategies have been developed, including hemiablation. Treatment success is still inconsistently defined. The only large randomized study available compares one of the procedures to standard therapy. Therefore, even in 2019, FT must still be regarded as experimental and should only be carried out within the context of studies. Follow-up should correspond to active surveillance (AS), including MRI and fusion biopsy. Advantages and disadvantages of each ablation technique should be taken into consideration as well as the suitability of certain regions in the gland. Ideally, an individualized "à la carte" selection of various procedures should be offered. FT is well suited for patients with highly localized cancers at intermediate risk if standard therapies or AS is not possible or has been refused.
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Affiliation(s)
- M Schostak
- Urologische Universitätsklinik, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland.
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24
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Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review. World J Urol 2019; 37:1517-1534. [DOI: 10.1007/s00345-019-02642-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/11/2019] [Indexed: 12/19/2022] Open
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25
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Miszczyk L, Stąpór-Fudzińska M, Miszczyk M, Maciejewski B, Tukiendorf A. Salvage CyberKnife-Based Reirradiation of Patients With Recurrent Prostate Cancer: The Single-Center Experience. Technol Cancer Res Treat 2018; 17:1533033818785496. [PMID: 29983098 PMCID: PMC6048607 DOI: 10.1177/1533033818785496] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate CyberKnife-based radioablation as a salvage
treatment for prostate cancer postirradiation relapses based on a group of patients
disqualified from available conventional methods of salvage treatment. Thirty-eight
patients were treated with a fraction dose varying from 5.5 to 10 Gy (median 7.35) to a
total dose of 18 to 36.25 Gy (median 36.25). In all, 55.3% of patients had androgen
deprivation therapy during this time. Nine patients had oligometastases in the salvage
time. The follow-up varied from 1.6 to 46.4 months (mean 19.7, median 14.4). In all, 92.6%
to 97.4% of patients had no gastrointestinal acute adverse effects; no effects higher than
G1 were noted. There were particular (up to 4.8%) G2 late gastrointestinal effects. The
percentage without genitourinary acute effects varied from 59.1% to 78.9%; 3.7% had G3
toxicity. G3 late genitourinary toxicity appeared 3 times, the maximal percentage being
12.5% (24 months after salvage treatment). The nadir of prostate-specific antigen median
was 0.24 ng/mL (9 months after treatment). Twelve (31.6%) patients failed in the timeline
of 6 to 42 months after salvage treatment (mean 18.7, median 16.5)—5 due to dissemination.
In 2 cases, progression in existing metastases was identified. Five (13.2%) patients had
biochemical failure without additional metastases (local relapses); hence, local control
was 86.8%. The failure risk is strongly influenced by initial disease stage and presalvage
prostate-specific antigen concentration. The obtained results permit us to conclude that
such a treatment could be an effective and safe option for prostate cancer postirradiation
relapse salvage treatment.
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Affiliation(s)
- Leszek Miszczyk
- 1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | | | - Bogusław Maciejewski
- 1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Andrzej Tukiendorf
- 3 Epidemioloy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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26
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Reichard C, Chapin BF. Can Focal Therapy Replace Radical Therapy for Prostate Cancer? Against Focal Therapy. Eur Urol Focus 2018; 3:524-525. [PMID: 29439879 DOI: 10.1016/j.euf.2018.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/17/2018] [Indexed: 10/18/2022]
Abstract
Until prospective data demonstrate the oncologic efficacy of focal therapy for clinically significant, localized prostate cancer, it should be considered as experimental and only performed within the confines of a clinical trial.
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Affiliation(s)
- Chad Reichard
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Brian Francis Chapin
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX, USA.
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27
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van der Poel HG, van den Bergh RCN, Briers E, Cornford P, Govorov A, Henry AM, Lam TB, Mason MD, Rouvière O, De Santis M, Willemse PPM, van Poppel H, Mottet N. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74:84-91. [PMID: 29373215 DOI: 10.1016/j.eururo.2018.01.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/02/2018] [Indexed: 11/16/2022]
Abstract
Radical treatment of localised prostate cancer is recognised to be an unnecessary intervention or overtreatment in many men. Consequently, there has been a rapid uptake in the use of focal ablative therapies. However, there are several biological and practical concerns about such approaches as they have yet to be proved as robust treatment options. In particular, the multifocal nature of prostate cancer argues against unifocal treatment, while limitations in imaging can preclude the accurate identification of the number, location, and extent of prostate cancer foci. To date, a number of ablative options have reported results on mainly low-risk disease. Most series are relatively immature, with a lack of consistent follow-up, and the morbidity of retreatment is often not considered. The authors consider focal therapy to be an investigational modality, and encourage prospective recording of outcomes and recruitment of suitable patients. PATIENT SUMMARY Focal therapy of prostate cancer is the targeted destruction of cancer within a specific part of the prostate gland, sparing the rest of the prostate and nearby tissue. This procedure could potentially reduce side effects when compared with established standard treatments, such as surgery or radiotherapy, which treat the entire prostate. Studies show that for most men with low-risk cancer, active surveillance is the preferred treatment option. However, the available data regarding all forms of focal therapy are still poor and inconclusive. Consequently, due to both the lack of clear results associated with focal therapy and the difficulties in detecting all cancerous areas of the prostate, focal therapy should be considered an investigational modality only.
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Affiliation(s)
- Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | | | | | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Alex Govorov
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital, Leeds, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Malcolm D Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Olivier Rouvière
- Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France
| | - Maria De Santis
- Clinical Trials Unit, University of Warwick, UK; Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | | | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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28
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Focal Therapy Versus Surveillance in Intermediate-Risk Cancer. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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29
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Smith JA. This Month in Adult Urology. J Urol 2017. [DOI: 10.1016/j.juro.2017.07.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Barret E, Sanchez-Salas R, Galiano M, Cathala N, Mombet A, Prapotnich D, Rozet F, Gangi A, Lang H, Cathelineau X. [Management of ablative therapies in prostate cancer]. Prog Urol 2017; 27:909-925. [PMID: 28918872 DOI: 10.1016/j.purol.2017.07.243] [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: 07/19/2017] [Accepted: 07/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To describe the specific modalities of ablative therapies management in prostate cancer. MATERIALS AND METHODS A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 61 articles were analysed. RESULTS Development of innovations such as ablative therapies in prostate cancer induces specific modalities in their management, during pre-, per- and post-procedure. More than for classical and well-known treatments, the decision to propose an ablative therapy requires analysis and consensus of medical staff and patient's agreement. Patient's specificities and economical aspects must also be considered. Procedures and follow-up must be realized by referents actors. CONCLUSION Indication, procedure and follow-up of ablative therapies in prostate cancer require specific modalities. They must be respected in order to optimize the results and to obtain a precise and objective evaluation for defining future indications.
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Affiliation(s)
- E Barret
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - R Sanchez-Salas
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - M Galiano
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - N Cathala
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Mombet
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - D Prapotnich
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - F Rozet
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France
| | - A Gangi
- Service de radiologie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 42, boulevard Jourdan, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France.
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