Oncological outcomes of salvage radical prostatectomy for recurrent prostate cancer in the contemporary era: A multicenter retrospective study

Giancarlo Marra, Robert Jeffrey Karnes, Giorgio Calleris, Marco Oderda, Paolo Alessio, Anna Palazzetti, Antonino Battaglia, Francesca Pisano, Stefania Munegato, Fernando Munoz, Claudia Filippini, Umberto Ricardi, Estefania Linares, Rafael Sanchez-Salas, Sanchia Goonewardene, Prokar Dasgupta, Ben Challacombe, Rick Popert, Declan Cahill, David GillattRaj Persad, Juan Palou, Steven Joniau, Salvatore Smelzo, Thierry Piechaud, Alexandre De La Taille, Morgan Roupret, Simone Albisinni, Roland van Velthoven, Alessandro Morlacco, Sharma Vidit, Giorgio Gandaglia, Alexander Mottrie, Joseph Smith, Shreyas Joshi, Gabriel Fiscus, Andre Berger, Monish Aron, Andre Abreu, Inderbir S. Gill, Henk Van Der Poel, Derya Tilki, Declan Murphy, Nathan Lawrentschuk, John Davis, Paolo Gontero

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Salvage radical prostatectomy (sRP) historically yields poor functional outcomes and high complication rates. However, recent reports on robotic sRP show improved results. Our objectives were to evaluate sRP oncological outcomes and predictors of positive margins and biochemical recurrence (BCR). Methods: We retrospectively collected data of sRP for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers in United States, Australia and Europe, from 2000 to 2016. SM and BCR were evaluated in a univariate and multivariable analysis. Overall and cancer-specific survival were also assessed. Results: We included 414 cases, 63.5% of them performed after radiotherapy. Before sRP the majority of patients had biopsy Gleason score (GS) ≤7 (55.5%) and imaging negative or with prostatic bed involvement only (93.3%). Final pathology showed aggressive histology in 39.7% (GS ≥9 27.6%), with 52.9% having ≥pT3 disease and 16% pN+. SM was positive in 29.7%. Five years BCR-Free, cancer-specific survival and OS were 56.7%, 97.7% and 92.1%, respectively. On multivariable analysis pathological T (pT3a odds ratio [OR] 2.939, 95% confidence interval [CI] 1.469–5.879; ≥pT3b OR 2.428–95% CI 1.333–4.423) and N stage (pN1 OR 2.871, 95% CI 1.503–5.897) were independent predictors of positive margins. Pathological T stage ≥T3b (OR 2.348 95% CI 1.338–4.117) and GS (up to OR 7.183, 95% CI 1.906–27.068 for GS >8) were independent predictors for BCR. Limitations include the retrospective nature of the study and limited follow-up. Conclusions: In a contemporary series, sRP showed promising oncological control in the medium term despite aggressive pathological features. BCR risk increased in case of locally advanced disease and higher GS. Future studies are needed to confirm our findings.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - 2021

Keywords

  • Open
  • Prostate cancer
  • Recurrence
  • Robotic
  • Salvage radical prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

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