Salvage partial gland ablation for recurrent prostate cancer following primary treatment with partial gland ablation: Functional and oncological outcomes
Yazan Qaoud1, Jaime Herrera-Caceres1, Roman Bass1, Katherine Lajkosz1, Mohamad Baker Berjaoui1, Raj Tiwari1, Nathan Perlis1, Neil E. Fleshner 1.
1Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
Introduction: Although salvage radical prostatectomy (sRP) is a well-described salvage option in cases of primary partial gland ablation (pPGA) the evidence supporting salvage PGA (sPGA) is limited.1,2 We report the oncological and functional outcomes of patients treated with sPGA following initial treatment with pPGA.
Methods: We performed a retrospective review of patients at three medical centers between 2005 and 2017. Oncological outcomes were assessed using biochemical recurrence (BCR) and biopsy-proven recurrence (BPR). Functional outcomes were described using the International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF), and rates of urinary incontinence (use of >1 pad/day).
Results: We identified 25 patients who underwent sPGA. High-intensity focused ultrasound (HIFU) was the main modality used. The median age and prostate-specific antigen (PSA) level at baseline were 65 years (interquartile range [IQR] 52–77) and 7.46 ng/mL (IQR 1–25), respectively. At BPR following pPGA, the majority of patients (42%) had PCa grade group 4 disease. The median length of followup from pPGA to last followup was 27.3 months (IQR 14.6–86.3). Following sPGA, 13/25 patients (52%) had BCR with a median time to recurrence of 14 months (IQR 2.5–82.15) and recurrence-free survival (RFS) of 24.5 months (95% confidence interval [CI] 15.3–NR). Of those 13 patients, four had sRP, four had salvage radiotherapy, three were managed with active surveillance, one had a third PGA, and one was managed with androgen deprivation therapy (ADT). The mean change from baseline to last followup in IPSS and IIEF scores was +1.3 (p=0.66) and -2.3 (p=0.32), respectively; 9% of patients had urinary incontinence at baseline, with only one additional patient developing incontinence following sPGA.
Conclusions: After undergoing two PGA procedures, results from our cohort demonstrate a favorable oncological outcome in 50% of patients after a median length of followup of 27.3 months, with non-significant effects on functional outcomes.
[1] Herrera-Caceres J, Woon DTS, Goldberg H, et al. SALVAGE PROSTATECTOMY AFTER FOCAL THERAPY; SINGLE CENTRE EXPERIENCE. Journal of Urology. 2018;199(4S):e49-e49.
[2] Marra G, Valerio M, Emberton M, et al. Salvage Local Treatments After Focal Therapy for Prostate Cancer. European urology oncology. 2019;2(5):526-538.
