Presentation Authors: Lorenzo Marconi*, Thomas Stonier, London, United Kingdom, Rafael Tourinho-Barbosa, Paris, France, Caroline Moore, Hashim U. Ahmed, London, United Kingdom, Xavier Cathelineau, Paris, France, Mark Emberton, London, United Kingdom, Sanchez-Salas Rafael, Paris, France, Paul Cathcart, London, United Kingdom
Introduction: There is no consensus on the optimal management of patients experiencing local recurrence after Focal Therapy(FT) for Prostate Cancer(PCa). Options include Surveillance, repeat focal ablation or transition to whole gland treatment, including Robotic Assisted Radical Prostatectomy(S-RALP) and radiotherapy(RT). In order to optimize treatment selection in this population, we sought to determine the risk factors for disease recurrence after S-RALP for failed FT.
Methods: Multi-centre cohort study of 82 consecutive patients submitted to S-RALP post FT. In all patients metastatic disease was excluded with a pelvic MRI, bone scan and/or PET-CT. A Cox Regression multivariate model was constructed to determine the impact of risk factors for biochemical recurrence after salvage surgery post FT. To adjust for inherent baseline differences among patients, we included age, number of FT treatments, type of FT(focal vs. hemigland ablation), timing of recurrence, preoperative PSA, tumour stage (T2 vs. T3a vs. T3b), ISUP grade (3,4 and 5 vs 1 and 2), positive margin status and site of recurrence post FT (infield vs. outfield only) as covariates.
Results: Thirty-four patients (41.5%) presented biochemical recurrence post S-RALP. Kaplan Meyer estimate of median biochemical recurrence free survival(bRFS) is 24[95%CI:18.8-29.2]months in the overall population. According to univariate analysis, patients who presented an infield recurrence presented with a shorter bRFS when compared to patients who presented outfield recurrence exclusively (28 vs. 40 months). Furthermore, patients with pT3b stage (Log Rank p=0.008), a positive surgical margin (Log Rank p=0.003), previously submitted to Local Ablation(vs. Hemiablation) (Log Rank=0.049), with early recurrences(Log Rank p=0.038) present a statistically significant worse median RFS. Age, number of previous FT treatments, pre S-RALP PSA, Positive margin and pre and post operative ISUP grade were not statistically significant predictors of Biochemical Recurrence post S-RALP. On multivariate analysis, only Infield Recurrence (HR[95%CI]=4.88[1.3-18.34]; p=0.019) and pT3b stage (HR[95%CI]=3.96 [1.22-12.82]; p=0.02) were independent predictors of recurrence. A patient with a recurrence within the previously treated FT field had almost 5 times more chance of developing recurrence post S-RALP. Biochemical recurrences after S-RALP were treated with HT(5patients), salvage RT +/- HT(18[52.9%]and 7[20.6%]patients, respectively), hormone and chemotherapy (1[2.9%] patient) and surveillance(1patient).
Conclusions: Men identified as having infield recurrence after FT appear to have phenoypically aggressive disease and as such should probably transition early to whole gland radical therapy and arguably utilising surgery as part of a multimodal approach to their disease, rather than having a further attempt at FT in the in-field recurrence.