Ribeiro, L;
Stonier, T;
Stroman, L;
Tourinho-Barbosa, R;
Alghazo, O;
Winkler, M;
Dasgupta, P;
... Cathcart, P; + view all
(2021)
Is the Toxicity of Salvage Prostatectomy Related to the Primary Prostate Cancer Therapy Received?
The Journal of Urology
, 205
(3)
pp. 791-799.
10.1097/JU.0000000000001382.
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Abstract
PURPOSE: To compare the toxicity profile and oncological outcome of salvage radical prostatectomy (SRP) following focal therapy (FT) versus SRP after radiation therapies (RT) - external beam radiation therapy (EBRT) or brachytherapy (BT). MATERIALS AND METHODS: Data concerning all men undergoing SRP for recurrent prostate cancer after either FT, EBRT or BT were retrospectively collected from 4 high volume surgical centres. The primary outcome measure of the study was toxicity of SRP characterized by any 30-day post-operative Clavien-Dindo complication rate, 12-month continence rate and 12-month potency rate. The secondary outcome was oncological outcome after SRP including positive margin rate and 12-month biochemical recurrence (BCR) rate. BCR was estimated using Kaplan-Meier methods and significant differences were calculated using a log rank test. Median follow-up time was 29.5 months. RESULTS: Between April 2007 and September 2018, 185 patients underwent SRP of which 95 had SRP after FT and 90 had SRP after RT, either EBRT or BT. SRP after RT was associated with a significantly higher 30-day Clavien-Dindo I-IV complication rate (34% vs 5%, p<0.001). At 12 months following surgery, patients undergoing SRP after FT had significantly better continence (SRP after FT:83% pad-free vs RT:49%) while potency outcomes were similar (FT:14% vs RT:11%). Men undergoing SRP after RT had a significantly higher stage and grade of disease together with a higher positive surgical margin rate (37% vs 13%, p=0.001). 3-year BCR after FT was 35% compared to 32% after RT, p=0.76. In multivariable analysis, men undergoing SRP after FT experienced a higher risk of BCR (HR 0.36 [0.18-0.82], p<0.005). CONCLUSIONS: This multicentre study demonstrates the toxicity of SRP in terms of perioperative complications and long-term urinary continence recovery is dependent on initial primary prostate cancer therapy received with men undergoing SRP after FT experiencing lower postoperative complication rates and better urinary continence outcomes.
| Type: | Article |
|---|---|
| Title: | Is the Toxicity of Salvage Prostatectomy Related to the Primary Prostate Cancer Therapy Received? |
| Location: | United States |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/JU.0000000000001382 |
| Publisher version: | http://dx.doi.org/10.1097/JU.0000000000001382 |
| Language: | English |
| Additional information: | This version is the version of record. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Outcomes Research, Prostate cancer, Quality of care, Recurrent Prostate Cancer, Salvage Radical Prostatectomy |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10112936 |
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