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Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy.
J Urol. 2017 May 24;:
Authors: Nunes-Silva I, Barret E, Srougi V, Baghdadi M, Capogrosso P, Garcia-Barreras S, Kanso S, Tourinho-Barbosa R, Carneiro A, Sanchez-Salas R, Rozet F, Galiano M, Cathelineau X
Abstract
PURPOSE: To assess the impact of focal therapy (FT) on perioperative, oncologic, and functional outcomes in men who underwent salvage robotic-assisted radical prostatectomy(S-RARP) compared to primary RARP (P-RARP).
MATERIALS AND METHODS: FT was performed in patients presenting Gleason score 3+3 or 3+4, clinical stage ≤cT2a, serum prostate-specific antigen(PSA) ≤15ng/ml, unilateral positive biopsy, maximum length of any positive core <10mm and life expectancy >10 years. FT was defined as target ablation of the index lesion plus 1cm of safety margin within the normal ipsilateral prostatic parenchyma. The S-RARP group included 22 men who underwent S-RARP after FT failure. The P-RARP group was defined using matched-pair 1:2 selection of 44 of 2750 P-RARP patients. The primary and secondary end points were between-group differences in functional and oncologic outcomes, respectively.
RESULTS: Complication rates were comparable (p>0.05). Pad-free probability was comparable between groups at 1 and 2 years(p=0.8). Recovery of erectile function was significantly lower with S-RARP(p=0.008), and S-RARP showed significantly lower probability of cumulative biochemical recurrence(BCR)-free survival (56.3% vs 92.4% at 2 years, p=0.001). S-RARP presented significantly increased risk of BCR (HR 4.8, 95% CI 1.67-13.76, p=0.004). Limitations included the retrospective nature, lack of randomization and short follow-up time.
CONCLUSIONS: S-RARP following FT failure is feasible, with acceptable complication rates. However, patients assigned to primary FT should be advised about a poorer prognosis in terms of oncological control and lower erectile recovery rates in case of a future salvage surgery.
PMID: 28551444 [PubMed - as supplied by publisher]
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