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Salvage Radical Prostatectomy after Primary Focal Ablative Therapy: A Systematic Review and Meta-Analysis
Fernando Blank1,2, Meredith Meyer1,2, Hannah Wang1
1Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA.
Cancers
|June 22, 2023
Summary
Salvage radical prostatectomy (sRP) after focal therapy (FT) for prostate cancer shows acceptable complication and oncologic outcomes. However, functional outcomes like continence and potency are suboptimal, and worse than primary prostatectomy.
Area of Science:
- Urology
- Oncology
- Surgical Oncology
Background:
- Focal therapy (FT) is increasingly used for localized intermediate-risk prostate cancer (PCa) due to lower morbidity.
- A small proportion of patients treated with FT experience local cancer recurrence, necessitating further intervention.
- Salvage radical prostatectomy (sRP) is a potential treatment option for recurrent PCa after FT failure.
Purpose of the Study:
- To systematically review and meta-analyze patient outcomes following sRP for recurrent PCa after primary FT.
- To evaluate postoperative complications, oncologic control, and functional results in this patient cohort.
- To compare outcomes of sRP after FT with those of primary radical prostatectomy (pRP).
Main Methods:
- A systematic review of three databases (PubMed, Embase, CINAHL) was conducted from October to December 2021.
- Data from 12 articles, including 482 patients who underwent sRP for post-FT recurrence, were analyzed.
- Meta-analysis was used to synthesize complication rates, positive surgical margins, biochemical recurrence, and functional outcomes.
Main Results:
- The median time to sRP was 24 months, with a median follow-up of 27 months.
- Postoperative complication rate was 15% (4.6% major complications), with 3.6% experiencing severe genitourinary toxicity.
- Oncologic outcomes included 27% positive surgical margins and 23% biochemical recurrence at 2 years.
- Functional outcomes at 12 months showed 67% continence and 37% potency.
Conclusions:
- sRP after FT failure demonstrates acceptable complication rates and oncologic outcomes.
- Functional outcomes, including continence and potency, are suboptimal following sRP.
- Outcomes after sRP for recurrent PCa post-FT are inferior compared to primary radical prostatectomy (pRP).
- Further high-quality research is needed to fully characterize outcomes for this treatment sequence.
