von Hardenberg, Jost ORCID: 0000-0002-0728-681X, Cash, Hannes ORCID: 0000-0002-1064-5633, Koch, Daniel, Borkowetz, Angelika, Bruendl, Johannes, Leyh-Bannurah, Sami-Ramzi, Kuru, Timur H., Kowalewski, Karl-Friedrich ORCID: 0000-0003-2931-6247, Schindele, Daniel, Mala, Katharina S., Westhoff, Niklas, Blana, Andreas and Schostak, Martin (2021). Triggers and oncologic outcome of salvage radical prostatectomy, salvage radiotherapy and active surveillance after focal therapy of prostate cancer. World J. Urol., 39 (10). S. 3747 - 3755. NEW YORK: SPRINGER. ISSN 1433-8726

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Abstract

Purpose Due to the tissue preserving approach of focal therapy (FT), local cancer relapse can occur. Uncertainty exists regarding triggers and outcome of salvage strategies. Methods Patients with biopsy-proven prostate cancer (PCa) after FT for localized PCa from 2011 to 2020 at eight tertiary referral hospitals in Germany that underwent salvage radical prostatectomy (S-RP), salvage radiotherapy (S-RT) or active surveillance (AS) were reported. Prostate specific antigen (PSA) changes, suspicious lesions on mpMRI and histopathological findings on biopsy were analyzed. A multivariable regression model was created for adverse pathological findings (APF) at S-RP specimen. Kaplan-Meier curves were generated to determine oncological outcomes. Results A total of 90 men were included. Cancer relapse after FT was detected at a median of 12 months (IQR 9-16). Of 50 men initially under AS 13 received S-RP or S-RT. In total, 44 men underwent S-RP and 13 S-RT. At cancer relapse 17 men (38.6%) in the S-RP group [S-RT n = 4 (30.8%); AS n = 3 (6%)] had ISUP > 2. APF (pT >= 3, ISUP >= 3, pN + or R1) were observed in 23 men (52.3%). A higher ISUP on biopsy was associated with APF [p = 0.006 (HR 2.32, 97.5% CI 1.35-4.59)] on univariable analysis. Progression-free survival was 80.4% after S-RP and 100% after S-RT at 3 years. Secondary therapy-free survival was 41.7% at 3 years in men undergoing AS. Metastasis-free survival was 80% at 5 years for the whole cohort. Conclusion With early detection of cancer relapse after FT S-RP and S-RT provide sufficient oncologic control at short to intermediate follow-up. After AS, a high secondary-therapy rate was observed.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
von Hardenberg, JostUNSPECIFIEDorcid.org/0000-0002-0728-681XUNSPECIFIED
Cash, HannesUNSPECIFIEDorcid.org/0000-0002-1064-5633UNSPECIFIED
Koch, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Borkowetz, AngelikaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bruendl, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Leyh-Bannurah, Sami-RamziUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuru, Timur H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kowalewski, Karl-FriedrichUNSPECIFIEDorcid.org/0000-0003-2931-6247UNSPECIFIED
Schindele, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mala, Katharina S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Westhoff, NiklasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Blana, AndreasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schostak, MartinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-599528
DOI: 10.1007/s00345-021-03700-x
Journal or Publication Title: World J. Urol.
Volume: 39
Number: 10
Page Range: S. 3747 - 3755
Date: 2021
Publisher: SPRINGER
Place of Publication: NEW YORK
ISSN: 1433-8726
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
Urology & NephrologyMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/59952

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