Complications, oncological and functional outcomes of salvage treatment options following focal therapy for localized prostate cancer: a systematic review and a comprehensive narrative review

Giancarlo Marra, Paolo Gontero, Jochen Christoph Walz, Arjun Sivaraman, Rafael Tourinho-Barbosa, Xavier Cathelineau, Rafael Sanchez-Salas

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)1517-1534
Number of pages18
JournalWorld Journal of Urology
Volume37
Issue number8
DOIs
StatePublished - Aug 1 2019
Externally publishedYes

Keywords

  • Focal therapy
  • Prostate cancer
  • Radical prostatectomy
  • Radiotherapy
  • Recurrence
  • Salvage treatment

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