Oncological outcomes of Salvage Radical Prostatectomy in a contemporary, multicentre series of 395 cases.
In men with biochemical recurrence (BCR) after primary treatment, salvage radical prostatectomy (sRP) can represent a valid therapeutic option with curative intent. Since current evidence mainly relies on outdated records, including patients treated 50 years ago, our aim was to assess the oncological outcomes in a large, contemporary series of sRP.
Between 2000 and 2016, 615 men with BCR underwent sRP at 18 Tertiary referral centres. We retrospectively collected pre-, intra and post-procedural clinical and pathological data, assessing erectile function (EF) and urinary continence (Con) before sRP, at 6 and/or 12 months. A follow up <6 months or unavailability of the data were exclusion criteria. Continuous variables were compared using Wilcoxon-Mann-Whitney test; Chi-square or Fisher&[prime]s exact tests were adopted for differences in categorical variables.</p>
We included 395 patients: 66.8% had been primarily treated with radiotherapy, 3.5% with cryotherapy, 3% with HIFU, 22.3% with brachytherapy and 3.3% with other primary treatments. Age pre-sRP and mean PSA were 66.3 (IQ 61.8-70.5) ys and 6.36 (IQ 2.5-7.3) ng/mL, respectively. Before sRP, no extra-nodal involvement was present, 143 men (37.1%) were on HT whereas 15 (3.8%) had castration resistant prostate cancer (CRPC). Mean ASA score was 2.17 ±0.78. Six patients (1.74%) underwent a super-extended lymphadenectomy, including retroperitoneal nodes, whilst a nerve sparing procedure was performed in 44 cases (14.1%). Mean operating time was 221.159 (IQ 150-250) min, with a mean blood loss of 439.979 (150-500) mL. At definitive histology, GS was ≥8 in 152 patients (43.43%) whereas 215 (54.7%) presented local extra-prostatic extension (T stage≥3) and 62 (18.73%) had positive nodes. About half of the cases (50.9%, n=165) had positive surgical margins. Forty patients (10.1%) experienced at least one major (Clavien ≥3) complication. Twelve months after surgery, only 8.1% had spontaneous or PDE-5 erections and 25.9% used ≥3pads/day (severely incontinent). After a median follow up of 3 (IQ 1.7-4.9) ys, 150, BCR was present in 48.39% of patients (n=150) and 20.47% had CRPC. Overall and cancer specific survival at 5 years were 95.02% and 96.2%, respectively.
Promising oncological outcomes are yielded by sRP, in short to medium term. Nevertheless, major complications and positive surgical margins are relatively frequent; rates of BCR and severe incontinence remain remarkable. Erectile function is poorly preserved. Prospective, long-term series are needed to confirm our findings.