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Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation.
BMC Urol. 2020 Jul 01; 20(1):81.BU

Abstract

BACKGROUND

Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and oncologic outcomes of sRARP.. The objective of this study was therefore to describe peri-operative safety, functional and early oncologic outcomes following salvage robot-assisted radical prostatectomy (sRARP) for local recurrence after HIFU-PA.

METHODS

Retrospective analysis of a prospective database of 53 consecutive men who underwent sRARP after HIFU-PA from 2012 to 2018. Continence and erectile-function were reported pre-HIFU, pre-sRARP, 3-months post-sRARP and 12-months post-sRARP. Complications, PSMs and need for subsequent ADT/radiotherapy were assessed.

RESULTS

45 men were suitable for inclusion and had sufficient data for analyses. Median duration from HIFU to sRARP was 30.0 months and median follow-up post-sRARP was 17.7 months. Median age, PSA and ISUP group were 63.0 yrs., 7.2 ng/mL and 2; 88.9% were cT2. Median operative-console time, blood loss and hospital stay were 140 min, 200 ml and 1 day respectively. Clavien-Dindo grade 1, 2 and 3 complications < 90 days occurred in 8.9, 6.7 and 2.2%; late (>90d) complications occurred in 13.2%. At sRARP pathology, ISUP 3-5 occurred in 51.1%, pT3a/b in 64.5%, and PSMs in 44.4% (37.5% for pT2, 48.3% for pT3). Of men with > 3-months follow-up after sRARP, 26.3% underwent adjuvant radiotherapy/ADT for residual disease or adverse pathologic features; 5.3% experienced BCR requiring salvage ADT/radiotherapy. Freedom from ADT/radiotherapy was 66.7% at 12-months. Pad-free rates were 100% pre-HIFU, 95.3% post-HIFU, 29.4% 3-months post-sRARP, and 65.5% 12-months post-sRARP. Median IIEF-5 scores pre-HIFU, post-HIFU, 3- and 12-months post-sRARP were 23.5, 16, 5 and 5, respectively. Potency rates were 81.8, 65.5, 0 and 0%, respectively. Bilateral/unilateral nerve sparing were feasible in 7%/22%.

CONCLUSION

Salvage RARP was safe with acceptable but sub-optimal continence and poor sexual-function and poor oncologic outcomes. One in three men required additional treatment within 12-months. This information may aid men and urologists with treatment selection and counselling regarding primary HIFU-PA vs primary RARP and when considering salvage RARP.

Authors+Show Affiliations

Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. drjethompson@gmail.com. Faculty of Medicine, University of New South Wales, Kensington, Australia. drjethompson@gmail.com.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. Division of Surgery & Interventional Sciences, University College London, London, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. Division of Surgery & Interventional Sciences, University College London, London, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. Centre for Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. Division of Surgery & Interventional Sciences, University College London, London, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. Division of Surgery & Interventional Sciences, University College London, London, UK.Department of Uro-oncology, University College London Hospital, London, W1G 8PH, UK. Division of Surgery & Interventional Sciences, University College London, London, UK. Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32611411

Citation

Thompson, James E., et al. "Peri-operative, Functional and Early Oncologic Outcomes of Salvage Robotic-assisted Radical Prostatectomy After High-intensity Focused Ultrasound Partial Ablation." BMC Urology, vol. 20, no. 1, 2020, p. 81.
Thompson JE, Sridhar AN, Shaw G, et al. Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation. BMC Urol. 2020;20(1):81.
Thompson, J. E., Sridhar, A. N., Shaw, G., Rajan, P., Mohammed, A., Briggs, T. P., Nathan, S., Kelly, J. D., & Sooriakumaran, P. (2020). Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation. BMC Urology, 20(1), 81. https://doi.org/10.1186/s12894-020-00656-9
Thompson JE, et al. Peri-operative, Functional and Early Oncologic Outcomes of Salvage Robotic-assisted Radical Prostatectomy After High-intensity Focused Ultrasound Partial Ablation. BMC Urol. 2020 Jul 1;20(1):81. PubMed PMID: 32611411.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Peri-operative, functional and early oncologic outcomes of salvage robotic-assisted radical prostatectomy after high-intensity focused ultrasound partial ablation. AU - Thompson,James E, AU - Sridhar,Ashwin N, AU - Shaw,Greg, AU - Rajan,Prabhakar, AU - Mohammed,Anna, AU - Briggs,Timothy P, AU - Nathan,Senthil, AU - Kelly,John D, AU - Sooriakumaran,Prasanna, Y1 - 2020/07/01/ PY - 2019/11/07/received PY - 2020/06/22/accepted PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline KW - HIFU KW - Prostate cancer KW - Radical prostatectomy KW - Robotics KW - Salvage therapy SP - 81 EP - 81 JF - BMC urology JO - BMC Urol VL - 20 IS - 1 N2 - BACKGROUND: Partial ablation of the prostate using high-intensity focussed ultrasound (HIFU-PA) is a treatment option for localised prostate cancer. When local recurrence occurs, salvage robot-assisted radical prostatectomy is a treatment option for selected patients, but there is a paucity of data on the peri-operative safety, functional and oncologic outcomes of sRARP.. The objective of this study was therefore to describe peri-operative safety, functional and early oncologic outcomes following salvage robot-assisted radical prostatectomy (sRARP) for local recurrence after HIFU-PA. METHODS: Retrospective analysis of a prospective database of 53 consecutive men who underwent sRARP after HIFU-PA from 2012 to 2018. Continence and erectile-function were reported pre-HIFU, pre-sRARP, 3-months post-sRARP and 12-months post-sRARP. Complications, PSMs and need for subsequent ADT/radiotherapy were assessed. RESULTS: 45 men were suitable for inclusion and had sufficient data for analyses. Median duration from HIFU to sRARP was 30.0 months and median follow-up post-sRARP was 17.7 months. Median age, PSA and ISUP group were 63.0 yrs., 7.2 ng/mL and 2; 88.9% were cT2. Median operative-console time, blood loss and hospital stay were 140 min, 200 ml and 1 day respectively. Clavien-Dindo grade 1, 2 and 3 complications < 90 days occurred in 8.9, 6.7 and 2.2%; late (>90d) complications occurred in 13.2%. At sRARP pathology, ISUP 3-5 occurred in 51.1%, pT3a/b in 64.5%, and PSMs in 44.4% (37.5% for pT2, 48.3% for pT3). Of men with > 3-months follow-up after sRARP, 26.3% underwent adjuvant radiotherapy/ADT for residual disease or adverse pathologic features; 5.3% experienced BCR requiring salvage ADT/radiotherapy. Freedom from ADT/radiotherapy was 66.7% at 12-months. Pad-free rates were 100% pre-HIFU, 95.3% post-HIFU, 29.4% 3-months post-sRARP, and 65.5% 12-months post-sRARP. Median IIEF-5 scores pre-HIFU, post-HIFU, 3- and 12-months post-sRARP were 23.5, 16, 5 and 5, respectively. Potency rates were 81.8, 65.5, 0 and 0%, respectively. Bilateral/unilateral nerve sparing were feasible in 7%/22%. CONCLUSION: Salvage RARP was safe with acceptable but sub-optimal continence and poor sexual-function and poor oncologic outcomes. One in three men required additional treatment within 12-months. This information may aid men and urologists with treatment selection and counselling regarding primary HIFU-PA vs primary RARP and when considering salvage RARP. SN - 1471-2490 UR - https://www.unboundmedicine.com/medline/citation/32611411/Peri-operative,_functional_and_early_oncologic_outcomes_of_salvage_robotic-assisted_radical_prostatectomy_after_high-intensity_focused_ultrasound_partial_ablation L2 - https://bmcurol.biomedcentral.com/articles/10.1186/s12894-020-00656-9 DB - PRIME DP - Unbound Medicine ER -
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