TY - JOUR
T1 - Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer
T2 - a systematic review and a comprehensive narrative review
AU - Marra, Giancarlo
AU - Gontero, Paolo
AU - Walz, Jochen Christoph
AU - Sivaraman, Arjun
AU - Tourinho-Barbosa, Rafael
AU - Cathelineau, Xavier
AU - Sanchez-Salas, Rafael
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Background: Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown. Objectives: To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT. Materials and methods: A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an ‘a priori protocol’. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT. Results: Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7–62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6–38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed. Conclusions: Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.
AB - Background: Whether focal therapy (FT) jeopardizes subsequent prostate cancer (PCa) salvage treatments, when needed, remains a major concern and is largely unknown. Objectives: To describe and report safety, oncological and functional outcomes of salvage treatments following PCa recurrence and/or persistence after FT. Materials and methods: A systematic review on salvage treatments for PCa recurrence/persistence after FT was carried out according to the PRISMA guidelines using an ‘a priori protocol’. A comprehensive literature review was also performed to investigate options to treat FT PCa recurrence/persistence that have not yet been reported after FT. Results: Four retrospective series were included (n = 67 men); overall quality of the studies was low. Salvage treatments yielded 32.8% (n = 22 of 67) biochemical recurrence rate (BCR) after a 7–62-months mean follow-up. No cancer-related deaths occurred. Patients experienced acceptable complications (n = 12 patients; n = 8 Clavien 3) and rare severe incontinence (4.5% using > 2 pads/day). Erectile function (EF) was rarely assessed (62.8% no information available), being overall poor. Other salvage options have been reported following whole-gland ablation and include: (1) re-do ablation yielding worst BCR and EF but similar complications and continence compared to first line ablation; (2) salvage radiotherapy yielding 16.6–38.8% BCR and acceptable toxicity profile with urinary and EF being poorly assessed. Conclusions: Current evidence is weak and limited to a few retrospective series. Oncological control is acceptable although it seems lower compared to a primary treatment setting. Functional outcomes are comparable to primary treatment with the exception of EF; overall, suggesting FT has little impact on subsequent salvage treatments. Future studies are needed to confirm the current findings.
KW - Focal therapy
KW - Prostate cancer
KW - Radical prostatectomy
KW - Radiotherapy
KW - Recurrence
KW - Salvage treatment
UR - http://www.scopus.com/inward/record.url?scp=85061008930&partnerID=8YFLogxK
U2 - 10.1007/s00345-019-02642-9
DO - 10.1007/s00345-019-02642-9
M3 - Review article
C2 - 30710157
AN - SCOPUS:85061008930
SN - 0724-4983
VL - 37
SP - 1517
EP - 1534
JO - World Journal of Urology
JF - World Journal of Urology
IS - 8
ER -