Hardenberg, Jost von and Cash, Hannes and Koch, Daniel and Borkowetz, Angelika and Bruendl, Johannes and Leyh-Bannurah, Sami-Ramzi and Kuru, Timur H. and Kowalewski, Karl-Friedrich and Schindele, Daniel and Mala, Katharina S. and Westhoff, Niklas and Blana, Andreas and Schostak, Martin (2021) Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer. WORLD JOURNAL OF UROLOGY, 39 (10). pp. 3747-3754. ISSN 0724-4983, 1433-8726
Full text not available from this repository. (Request a copy)Abstract
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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ; Prostate neoplasms; Salvage therapy; Focal therapy; Partial gland ablation; Hemi-ablation; High-intensity focused ultrasound; Multiparametric magnetic resonance imaging |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Urologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 23 Sep 2022 05:13 |
| Last Modified: | 23 Sep 2022 05:13 |
| URI: | https://pred.uni-regensburg.de/id/eprint/47889 |
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