Presentation Authors: Luca Boeri*, Vidit Sharma, Igor Frank, Stephen A. Boorjian, R. Houston Thompson, Matthew Tollefson, John C. Cheville, R. Jeffrey Karnes, Rochester, MN
Introduction: Focal salvage therapies (FST) for locally recurrence prostate cancer (PCa) after primary radiotherapy (RT) can reduce the risk of adverse events associated with salvage radical prostatectomy (sRP) while maintaining cancer control, in selected patients. However, the risk of missing adverse PCa features undergoing FST instead of sRP has never been investigated. We aimed to assess the rates and predictors of adverse PCa features in patients eligible for FST who ultimately underwent sRP.
Methods: We reviewed 120 patients with locally recurrent PCa after RT who underwent sRP and extended pelvic lymph node dissection (2000-2016). Metastatic disease was excluded by choline PET and bone scan. Pre RT PSA, clinical stage (cT), biopsy Gleason score (GS) prior to RT and prior to sRP, PSA nadir, PSA prior to surgery, and pathohistology of sRP specimens were analysed. Eligibility criteria for FST were based on EAU Guidelines: cT1-cT2 PCa, initial GS â‰¤7 and pre-salvage PSA < 10 ng/mL. Adverse features after sRP were defined as: GS â‰¥8, pN+ and seminal vesicle invasion (SVI) at sRP. Descriptive statistics and logistic regression models were used to describe the whole cohort.
Results: Overall, the median (interquartile range) age at sRP was 66.8 (62.1-71.7) years and the median pre sRP PSA was 4.2 (2.2-7.6) ng/mL. 63 (52.5%) patients had a GS â‰¤7 and 54 (45%) men had cT1 disease prior to sRP. According to EAU Guidelines, 55 (45.8%) patients were eligible for FST. Among those, 22 (40%) patients had adverse PCa features after sRP. In particular, SVI, pN+ and GS â‰¥8 at sRP were found in 12 (21.8%), 9 (16.4%) and 7 (12.7%) men, respectively. In patients with indications for FST, those with adverse PCa features at sRP had higher PSA nadir (0.9 vs. 0.4 ng/mL; p=0.019) and higher rates of GS 4+3 PCa pre sRP (54.5% vs. 18.2%, p=0.01) than those without adverse PCa features. At univariable logistic regression analysis, pre surgical GS 4+3 (p=0.003) and higher PSA nadir (p=0.018) were associated with the risk of having adverse features at sRP while age, cT, PSA prior to sRP were not.
Conclusions: Approximately 40% of patients potentially eligible for FST showed adverse PCa characteristics when submitted to sRP. In particular 22% and 16% of those will have SVI and pN+ disease. A confirmatory GS 4+3 biopsy for recurrence and higher PSA nadir were associated with the risk of having adverse PCa features at salvage surgery. These results suggest the need for improving the selection of candidates for FST.