Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer
| Autor: | Daniel Koch, Daniel Schindele, Sami-Ramzi Leyh-Bannurah, Katharina S. Mala, Angelika Borkowetz, Johannes Bruendl, Martin Schostak, Andreas Blana, Jost von Hardenberg, T. Kuru, Niklas Westhoff, Karl-Friedrich Kowalewski, Hannes Cash |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Nephrology
Male medicine.medical_specialty Urology medicine.medical_treatment Partial gland ablation Salvage therapy Kaplan-Meier Estimate Prostate cancer Focal therapy Internal medicine Multiparametric magnetic resonance imaging Biopsy medicine Hemi-ablation Humans Prostate neoplasms Watchful Waiting Aged Prostatectomy Salvage Therapy medicine.diagnostic_test Radiotherapy business.industry Prostatic Neoplasms Middle Aged Prostate-Specific Antigen medicine.disease Progression-Free Survival Prostate-specific antigen High-intensity focused ultrasound Cohort Multivariate Analysis High-Intensity Focused Ultrasound Ablation Regression Analysis Prostate neoplasm Original Article Neoplasm Recurrence Local business |
| Zdroj: | World Journal of Urology |
| ISSN: | 1433-8726 0724-4983 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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