Radical prostatectomy after vascular-targeted photodynamic therapy (VTP) with TOOKAD® : feasibility, early and intermediate results

Abstract

Introductionand objectives: vascular-targeted photodynamic therapy with TOOKAD® (VTP) is a new therapeutic option for localized prostate cancer (PCa) management. The objectives are to assess the feasibility of radical prostatectomy (RP) after VTP and describe functional and oncological outcomes. Material and Methodswe retrospectively included 45 patients who underwent salvage RP after VTP for recurrent PCa in 14 surgical centres in Europe between October 2008 and March 2017.Forty-two RP were performed: 16 robot-assisted, 6 by laparoscopy, and 20 by open surgery. Primary endpoints were morbidity and technical difficulties. Secondary endpoints were early and intermediate post-operative functional and oncologic outcomes. ResultsMedian operative time was 180 (150-223) minutes. Median blood loss was 200 (155-363) millilitres. According to the surgeons, the surgery was “easy” for 29 patients (69%), “difficult” for 13 patients (31%). Nerve sparing was feasible for 14 patients (33%). Five (12%) post-operative complications were found: 2 Claviens I, 2 Clavien II and 1 Clavien IIIB. There was 13 pT3 (31%), 21 (50%) pT2c. Surgical margins were positive for 13 patients (31%). PSA was undetectable at 6-12 months for 37 patients (88%). Nine patients had complementary radiotherapy. Four patients had a last PSA > 0.2 ng/mL with a median follow-up of 23 (12-36) months. At one year, 27 patients (64%) were completely continent (no pads), 10 (24%) had low incontinence (1 pads). Four patients (11 %) recovered potency without treatment, and 23 (64%) with appropriate treatment. ConclusionSalvage RP after VTP treatment was feasible and safe without difficulties for most of the surgeons.