Presentation Authors: Paolo Gontero, Giancarlo Marra, Paolo Alessio, Giorgio Calleris, Antonino Battaglia, Claudia Filippini, Stefania Munegato, Torino, Italy, Fernando Munoz, Aosta, Italy, Marco Oderda, Anna Palazzetti, Francesca Pisano, Umberto Ricardi, Torino, Italy, Estefania Linares, Rafael Sanchez-Salas, Paris, France, Ben Challacombe, Paul Cathcart, Prokar Dasgupta, Sanchia Goonewardene*, Rick Popert, Declan Cahill, London, United Kingdom, David Gillatt, Raj Persad, Bristol, United Kingdom, Juan Palou, Barcelona, Spain, Steven Joniau, Leuven, Belgium, Thierry Piechaud, Salvatore Smelzo, Bordeaux, France, Alexandre De La Taille, Créteil, France, Morgan Roupret, Paris, France, Simone Albisinni, Roland Van Velthoven, Bruxelles, Belgium, Alessandro Morlacco, Sharma Vidit, Rochester, MN, Giorgio Gandaglia, Alexander Mottrie, Aalst, Belgium, Joseph Smith, Shreyas Joshi, Gabriel Fiscus, Nashville, TN, Andre Berger, Monish Aron, Andre Abreu, Inderbir S. Gill, Los Angeles, CA, Henk Van Der Poel, Amsterdam, Netherlands, Derya Tilki, Hamburg, Germany, Nathan Lawrentschuk, Declan G. Murphy, Melbourne, Victoria, Australia, Gordon Leung, John Davis, Houston, TX, Robert J. Karnes, Rochester, MN
Introduction: A curative option in men with biochemical recurrence (BCR) after primary treatment is represented by salvage radical prostatectomy (sRP). To enhance cancer control and benefit-risk ratio, patient selection is definitely the key. According to EAU guidelines, sRP candidates should have low comorbidities, pre-sRP PSA < 10 ng/mL, pre-sRP biopsy Gleason Score (GS) â‰¤ 8, no evidence of lymph-node or extra-nodal metastases and previous organ-confined disease. We compared histological and oncological outcomes between patients compliant and non-compliant with these requirements.
Methods: Seventy-three full-EAU-compliant (lower-risk, Group A) and 236 non-EAU-compliant patients (higher risk, group B) were retrospectively enrolled, drawing from a database of 615 sRP performed between 2000 and 2016 at 18 tertiary referral centres. We assessed pre-, intra and post-procedural clinical and histological data. A follow up < 6 months or unavailability of the data were exclusion criteria. Continuous variables were compared using Wilcoxon-Mann-Whitney test; differences in categorical variables were assessed by Chi-square or Fisher&[prime]s exact tests.
Results: No significant difference between Group A and B was observed as for median age at sRP (65.57 vs 66.91 years, p=0,11) and follow-up duration (3.43 vs 3.12 years, p=0,16). As obvious, PSA before salvage surgery was significantly higher among Group B patients (5.0 [IQR: 2.5-5.4] vs 3.8 [IQR 2.6 vs 9.0] ng/ml, p=0,01), as well as ASA score and GS distribution at confirmatory biopsy. Organ-confined disease at sRP (pT2) was encountered in 68.5% vs 35.9% (p < 0,01), pN1 disease in 7.8% vs 23.5% (p < 0,01) and of GSâ‰¥8 disease in 8.8% vs 56.1% (p < 0,01), of men belonging to Group A vs Group B, respectively. In the higher risk group, positive surgical margins were more common (43% vs 27%, p=0,02). Lower-risk group showed a nearly doubled BCR-free survival at last follow-up (64.4% vs 37.9%, p>0,01). Besides, proportions of patients alive at last follow-up were similar: 94,5% vs 93,6% for Group A vs B, respectively.
Conclusions: For well-selected patients affected by recurrent PCa after non-surgical treatment, sRP entails promising short-term oncological outcomes, along with considerable morbidity. More than the half (64.4%) of men fully-compliant to EAU selection criteria is still disease-free 3 years after sRP. These data suggest that potentially-curative surgical salvage treatment should not be precluded upfront. Large long-term series are needed to confirm sRP benefits and to improve patient selection.