Radiation-recurrent Prostate Cancer Research Articles

Salvage Robot-Assisted Radical Prostatectomy (sRARP) for Radiation-Recurrent Prostate Cancer: a Single-Center Experience.

This case series reported on five patients with radiation-recurrent localized prostate cancer (PCa) who underwent salvage robot-assisted radical prostatectomy (sRARP). Median postoperative follow-up period was 8months. Median (range) peri-operative parameters such as operative time, the estimated blood loss, and length of hospital stay were 127min (113-158), 61ml (54-111), and 9days (8-11), respectively. None of the five patients required conversion to an open approach or required a blood transfusion, or experienced a rectal/ureteral injury. Urinary leakage was present in one patient (20%) at the initial cystogram. Transurethral electrocoagulation under spinal anesthesia was required to control hematuria in one patient (20%). Two patients (40%) experienced biochemical progression; no patient died from PCa or other causes during the follow-up period. Of five patients, three (60%) were continent. For patients with radiation-recurrent localized PCa, sRARP might become a feasible surgical option with acceptable outcomes.

PD35-03 THE SIGNIFICANCE OF DE-RITIS RATIO IN PATIENTS WITH RADIATION-RECURRENT PROSTATE CANCER UNDERGOING SALVAGE RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 May 2022PD35-03 THE SIGNIFICANCE OF DE-RITIS RATIO IN PATIENTS WITH RADIATION-RECURRENT PROSTATE CANCER UNDERGOING SALVAGE RADICAL PROSTATECTOMY Fahad Quhal, Ekaterina Laukhtina, Benjamin Pradere, Pawel Rajwa, Axel Heidenreich, and Shahrokh F. Shariat Fahad QuhalFahad Quhal More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , and Shahrokh F. ShariatShahrokh F. Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002593.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the clinical prognostic value of preoperative serum De Ritis Ratio (Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT)) on postoperative survival outcomes in patients with radiation-recurrent prostate cancer who underwent salvage radical prostatectomy (SRP). METHODS: A retrospective review was conducted of patients with radiation-recurrent prostate cancer who underwent SRP in five tertiary referral centers from 2007 to 2015. An increased pre-operative serum De Ritis ratio was defined as ≥1.35. The association between De Ritis Ratio and postoperative outcomes was tested. Multivariate Cox analyses were performed to identify the independent predictors of Biochemical recurrence free survival (BCRFS), metastases free survival (MFS), overall survival (OS) and cancer specific survival (CSS). RESULTS: Overall 214 patients underwent SRP, out of them 98 (45.8%) patients with high serum De Ritis Ratio, were included in the study. In a multivariate analysis high De Ritis Ratio was an independent predictor of Biochemical Recurrence (BCR) (hazard ratio (HR) 1.79, 95% Confidence Interval (CI) 1.16-2.78, p-value 0.009) (Figure 1). No significant association was found between pre-operative DRR and MFS (HR 1.32, 95% CI 0.53-3.30, P=0.55), OS (HR 2.35, 95% CI 0.84-6.57, P=0.10) and CSS (HR 3.36, 95%CI 0.65-17.35, P=0.15). CONCLUSIONS: Increased preoperative serum DRR is associated with the development of BCR in patients with radiation-recurrent prostate cancer who underwent SRP. DRR might serve as an early indicator for BCR, which may facilitate recognition of potential relapse and could translate into more intense follow-up and even salvage therapy in selected patients. Source of Funding: No funding © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e628 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fahad Quhal More articles by this author Ekaterina Laukhtina More articles by this author Benjamin Pradere More articles by this author Pawel Rajwa More articles by this author Axel Heidenreich More articles by this author Shahrokh F. Shariat More articles by this author Expand All Advertisement PDF DownloadLoading ...

A0969 - The role of lymph node dissection in patients undergoing salvage radical prostatectomy for radiation recurrent prostate cancer

A0969 - The role of lymph node dissection in patients undergoing salvage radical prostatectomy for radiation recurrent prostate cancer

Comment on: "Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer"

article: Comment on: “Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer” - Minerva Urology and Nephrology 2021 October;73(5):683-5 - Minerva Medica - Journals

Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer.

Background Serum albumin-to-globulin ratio (AGR) has been shown to be associated with poor prognosis in different malignancies. In this study we aimed to evaluate the predictive value of preoperative AGR for oncological outcomes in patients with radiation recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP). Methods A retrospective review of 214 consecutive patients with radiation-recurrent PCa who underwent SRP at five referral centers. Levels of albumin and globulin were obtained before SRP and used to calculate the preoperative AGR level. The optimal cut off value of preoperative AGR was 1.4. Univariable and multivariable Cox regression analyses were performed. Results Overall 89 (41.6%) patients had a low preoperative AGR. Low serum AGR was associated with biochemical recurrence (BCR) in univariable Cox regression analysis (HR 1.60, 95%CI 1.06-2.43, P=0.026). When adjusted for the effects of established preoperative and postoperative clinicopathologic confounders in different multivariable Cox regression models, this association did not retain its statistical significance. Moreover, preoperative AGR was not associated with metastasis free survival (P= 0.21), overall survival (P= 0.91) or cancer specific survival (P=0.61). Conclusions In patients with radiation recurrent PCa undergoing SRP, low preoperative AGR was associated with the risk of BCR only in univariable analysis. There was no association with metastasis or survival outcomes. Further studies are needed to evaluate this biomarker in the setting of primary PCa and to identify the patients most likely to benefit from a local therapy.

MP15-10 THE ROLE OF LYMPH NODE DISSECTION IN PATIENTS UNDERGOING SALVAGE RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP15)1 Sep 2021MP15-10 THE ROLE OF LYMPH NODE DISSECTION IN PATIENTS UNDERGOING SALVAGE RADICAL PROSTATECTOMY Fahad Quhal, Pawel Rajwa, Keiichiro Mori, Ekaterina Laukhtina, Nico C. Grossmann, Abdulmajeed Aydh, Reza Sari Motlagh, Satoshi Katayama, Hadi Mostafai, Benjamin Pradere, Paolo Gontero, Romain Mathieu, Pierre I. Karakiewicz, Alberto Briganti, Axel Heidenreich, and Shahrokh Shariat Fahad QuhalFahad Quhal More articles by this author , Pawel RajwaPawel Rajwa More articles by this author , Keiichiro MoriKeiichiro Mori More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Nico C. GrossmannNico C. Grossmann More articles by this author , Abdulmajeed AydhAbdulmajeed Aydh More articles by this author , Reza Sari MotlaghReza Sari Motlagh More articles by this author , Satoshi KatayamaSatoshi Katayama More articles by this author , Hadi MostafaiHadi Mostafai More articles by this author , Benjamin PradereBenjamin Pradere More articles by this author , Paolo GonteroPaolo Gontero More articles by this author , Romain MathieuRomain Mathieu More articles by this author , Pierre I. KarakiewiczPierre I. Karakiewicz More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , and Shahrokh ShariatShahrokh Shariat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001996.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer (PCa) recurrence after primary radiotherapy is increasingly encountered. Radical prostatectomy is a salvage local treatment with potentially durable disease control for these patients. Here, we sought to examine the effect of lymph node dissection on the outcomes of patients with radiation-recurrent PCa who underwent salvage radical prostatectomy (SRP). METHODS: A retrospective review of patients with radiation-recurrent PCa who underwent SRP at six referral centers from 2000 to 2016. Recurrence after radiotherapy was defined as a prostate specific antigen (PSA) increase of ≥2 ng/mL above the nadir. All patients underwent a pre-SRP biopsy. Biochemical recurrence (BCR) was defined as PSA value of ≥0.2 ng/mL after SRP. The effect of the number of removed lymph nodes (RLNs) and positive lymph nodes (PLNs) on BCR-free survival, metastases free survival, overall survival (OS) was tested in multivariate Cox regression analyses. RESULTS: Overall, 334 patients underwent SRP and pelvic lymph node dissection. The median age and PSA at surgery were 68 years, and 3.55 ng/mL, respectively. The median follow up duration was 22.9 months (IQR 4.6-33.2) Lymph node involvement( LNI) was associated with increased risk of BCR (HR 2.18, p<0.001), metastasis (HR 3.93, p<0.001) and overall mortality (HR 2.88, p=0.006). In a multivariate cox regression analysis, an increased number of RLNs significantly reduced the risk of BCR (HR 0.96, p=0.01). In patients with positive lymph nodes, a higher number of RLN and a lower number of PLNs were both associated with improved freedom from BCR (HR 0.89, p= 0.001 and HR 1.34, p=0.008, respectively).The number of RLNs was not significantly associated with MFS. However, patients with ≥two positive lymph nodes were at a significantly increased risk of developing metastasis (HR 3.72, p=0.017). Neither the number of RLNs nor the number of PLNs were significantly associated with OS. In logistic regression analysis, an increased number of RLNs was associated with a higher probability of finding positive lymph nodes. CONCLUSIONS: LNI increased the risk of BCR, metastasis and overall mortality in radiation-recurrent PCa patients undergoing SRP. The increased number of RLNs improved staging through a higher probability of detecting LNI. Furthermore, an increased number of RLNs during SRP reduced the risk of BCR, hinting at a possible therapeutic benefit. However, further research with standardized lymph node templates is needed to support this conclusion and develop a precise therapeutic adjuvant strategy based on the number of RLNs and the number of PLNs. Source of Funding: No funding © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e267-e268 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fahad Quhal More articles by this author Pawel Rajwa More articles by this author Keiichiro Mori More articles by this author Ekaterina Laukhtina More articles by this author Nico C. Grossmann More articles by this author Abdulmajeed Aydh More articles by this author Reza Sari Motlagh More articles by this author Satoshi Katayama More articles by this author Hadi Mostafai More articles by this author Benjamin Pradere More articles by this author Paolo Gontero More articles by this author Romain Mathieu More articles by this author Pierre I. Karakiewicz More articles by this author Alberto Briganti More articles by this author Axel Heidenreich More articles by this author Shahrokh Shariat More articles by this author Expand All Advertisement Loading ...

The role of lymph node dissection in salvage radical prostatectomy for patients with radiation recurrent prostate cancer.

PurposeTo examine the effect of lymph node dissection on the outcomes of patients who underwent salvage radical prostatectomy (SRP).Material and MethodsWe retrospectively reviewed data from radiation‐recurrent patients with prostate cancer (PCa) who underwent SRP from 2000–2016. None of the patients had clinical lymph node involvement before SRP. The effect of the number of removed lymph nodes (RLNs) and the number of positive lymph nodes (PLNs) on biochemical recurrence (BCR)‐free survival, metastases free survival, and overall survival (OS) was tested in multivariable Cox regression analyses.ResultsAbout 334 patients underwent SRP and pelvic lymph node dissection (PLND). Lymph node involvement was associated with increased risk of BCR (p < .001), metastasis (p < .001), and overall mortality (p = .006). In a multivariable Cox regression analysis, an increased number of RLNs significantly lowered the risk of BCR (hazard ratio [HR] 0.96, p = .01). In patients with positive lymph nodes, a higher number of RLNs and a lower number of PLNs were associated with improved freedom from BCR (HR 0.89, p = .001 and HR 1.34, p = .008, respectively). At a median follow‐up of 23.9 months (interquartile range, 4.7–37.7), neither the number of RLNs nor the number of PLNs were associated with OS (p = .69 and p = .34, respectively).ConclusionPathologic lymph node involvement increased the risk of BCR, metastasis and overall mortality in radiation‐recurrent PCa patients undergoing SRP. The risk of BCR decreased steadily with a higher number of RLNs during SRP. Further research is needed to support this conclusion and develop a precise therapeutic adjuvant strategy based on the number of RLNs and PLNs.

Functional Outcomes after Local Salvage Therapies for Radiation-Recurrent Prostate Cancer Patients: A Systematic Review.

Simple SummaryLocal salvage therapies are offered to prostate cancer (PCa) patients with recurrent disease following primary radiation therapy with initial curative intent. Favorable oncologic outcome is the primary aim of salvage therapy, but many patients may be left with treatment-related adverse consequences, potentially affecting their quality of living. The aim of this review was to evaluate the rates and severity of various functional outcomes after salvage therapy in patients with radiation recurrent PCa. Local salvage therapies are associated with impaired urinary and sexual functions depending on the specific salvage strategy. However, accurate estimation of the likelihood of these sequalae may be predictable based on the high pre-salvage general and disease specific health status. Despite these adverse consequences and impaired quality of life, oncologic advantage of local salvage treatment post radiation recurrence prostate cancer seems justified in general, but shared decision working with an informed patient is essential. This paper serves as a discussion platform for this process.Purpose: To assess the rate and severity of functional outcomes after salvage therapy for radiation recurrent prostate cancer. Methods: This systematic review of the MEDLINE/PubMed database yielded 35 studies, evaluating salvage radical prostatectomy (RP), brachytherapy (BT), high-intensity focal ultrasound (HIFU) and cryotherapy (CT) after failure of primary radiation therapy. Data on pre- and post-salvage rates and severity of functional outcomes (urinary incontinence, erectile dysfunction, and lower urinary tract symptoms) were collected from each study. Results: The rates of severe urinary incontinence ranged from 28–88%, 4.5–42%, 0–6.5%, 2.4–8% post salvage RP, HIFU, CT and BT, respectively. The rates of erectile dysfunction were relatively high reaching as much as 90%, 94.6%, 100%, 62% following RP, HIFU, CT and BT, respectively. Nonetheless, the high pre-salvage rates of ED preclude accurate estimation of the effect of salvage therapy. There was an increase in the median IPSS following salvage HIFU, BT and CT ranging from 2.5–3.4, 3.5–12, and 2, respectively. Extended follow-up showed a return-to-baseline IPSS in a salvage BT study. The reported data suffer from selection, reporting, publication and period of study biases, making inter-study comparisons inappropriate. Conclusions: local salvage therapies for radiation recurrent PCa affect continence, lower urinary tract symptoms and sexual functions. The use of local salvage therapies may be warranted in the setting of local disease control, but each individual decision must be made with the informed patient in a shared decision working process.

P033 - The significance of De-Ritis ratio in patients with radiation-recurrent prostate cancer undergoing salvage radical prostatectomy

P033 - The significance of De-Ritis ratio in patients with radiation-recurrent prostate cancer undergoing salvage radical prostatectomy

Prognostic value of preoperative albumin to globulin ratio in patients treated with salvage radical prostatectomy for radiation recurrent prostate cancer.

Serum albumin-to-globulin ratio (AGR) has been shown to be associated with poor prognosis in different malignancies. In this study we aimed to evaluate the predictive value of preoperative AGR for oncological outcomes in patients with radiation recurrent prostate cancer (PCa) treated with salvage radical prostatectomy (SRP). A retrospective review of 214 consecutive patients with radiation recurrent PCa who underwent SRP at five referral centers. Levels of albumin and globulin were obtained before SRP and used to calculate the preoperative AGR level. The optimal cut off value of preoperative AGR was 1.4. Univariable and multivariable Cox regression analyses were performed. Overall 89 (41.6%) patients had a low preoperative AGR. Low serum AGR was associated with biochemical recurrence (BCR) in univariable Cox regression analysis (HR 1.60, 95%CI 1.06-2.43, P=0.026). When adjusted for the effects of established preoperative and postoperative clinicopathologic confounders in different multivariable Cox regression models, this association did not retain its statistical significance. Moreover, preoperative AGR was not associated with metastasis free survival (P=0.21), overall survival (P=0.91) or cancer specific survival (P=0.61). In patients with radiation recurrent PCa undergoing SRP, low preoperative AGR was associated with the risk of BCR only in univariable analysis. There was no association with metastasis or survival outcomes. Further studies are needed to evaluate this biomarker in the setting of primary PCa and to identify the patients most likely to benefit from a local therapy.

The Scottish prostate cryotherapy service–the role of the clinical nurse specialist

This article outlines the role of the clinical nurse specialist in establishing a Scotland-wide national designated service for prostate cryotherapy for patients with radiation-recurrent prostate cancer. The service was established in 2009 and provides prostate cryotherapy across Scotland. This article reviews and discusses the challenges involved in setting up a new service for tertiary treatment as well as highlighting the key achievements of the service. The challenges have included introducing the cryotherapy procedure in a safe and quality assured manner, developing and refining the referral process, educating both primary and secondary care teams on salvage prostate cryotherapy as a treatment modality and surgical procedure, as well as managing of complications following salvage prostate cryotherapy. The article also outlines the achievements of both the service and the treatment as well as how the service has developed since 2009.

Role of serum cholinesterase in patients treated with salvage radical prostatectomy

BackgroundSerum cholinesterase (ChE) a serine hydrolase that catalyses the hydrolysis of esters of choline, is involved in cellular proliferation and differentiation, therefore affecting carcinogenesis. The aim of this study was to understand the prognostic role of preoperative serum ChE in patients with radiation-recurrent prostate cancer (CaP) treated with salvage radical prostatectomy (SRP). Material and methodsThis retrospective study included 214 patients with radiation-recurrent CaP treated with SRP from January 2007 to December 2015 at 5 academic centers. Patients were considered with abnormal/decreased ChE levels if <5 kU/l. Biochemical recurrence-free and metastases-free (MFS) survival analyses were performed. ResultsMedian serum ChE level was 6.9 (interquartile range) 6–7.7) kU/l. Serum ChE level (<5 kU/l) was decreased in 25 (11.7%) patients. Decreased serum ChE level was associated with lower body mass index (P = 0.006) and metastasis to lymph nodes (P = 0.004). In multivariable analysis, continuous ChE was an independent predictor of MFS (hazard ratio [HR] 0.48, confidence interval [CI] 0.33–0.71, P < 0.001), overall survival (HR 0.68, CI 0.48–0.96, P = 0.03) and cancer-specific survival (HR 0.41, CI 0.2–0.84, P = 0.01). Serum ChE improved the C-index (by 2.54%) to 87.8% for prediction of overall survival and (by 3%) to 92% for prediction of MFS. ConclusionPreoperative serum ChE is associated with the development of metastasis in patients with radiation-recurrent CaP who underwent SRP. The biological underpinning of this association with the biological and clinical aggressiveness of CaP needs to be further elucidated.

Место сальважной радикальной простатэктомии, криоаблации и HIFU-аблации в ведении пациентов с рецидивом рака простаты после лучевой терапии

Several options for salvage treatment of radiation-recurrent prostate cancer exist. The main option is a salvage radical prostatectomy, which offers optimal cancer control and allows to perform specimen pathology, but it is technically challenging and poses increased risk for certain complications. Alternative modalities of salvage therapy are HIFU-ablation and cryoablation. This review covers the role for those methods, their oncological efficacy and morbidity.

Oncologic Effect of Cumulative Smoking Exposure in Patients Treated With Salvage Radical Prostatectomy for Radiation-recurrent Prostate Cancer.

The purpose of the present study was to investigate the association of smoking with biochemical recurrence (BCR) and metastasis in radiation-recurrent prostate cancer (PCa) patients undergoing salvage radical prostatectomy (SRP). A total of 214 patients treated with SRP for radiation-recurrent PCa in 5 tertiary referral centers were included from January 2007 to December 2015. Kaplan-Meier analyses were used to assess the time to BCR and metastasis. Pre- and postoperative multivariable Cox proportional hazard regression models were fitted. Overall, 120 (56.1%), 49 (22.9%), and 45 (21%) patients were never, former, and current smokers, respectively. Low-, medium-, and high-cumulative smoking exposure was registered in 59.8%, 16.4%, and 23.8% of cases, respectively. Patients with high cumulative smoking exposure had a significantly greater rate of a pathologic Gleason score of≥ 8 (P= .01) and extracapsular extension (P= .004). Smoking status, cumulative smoking exposure, intensity, and duration were significantly associated with BCR-free survival (P<.001 for all). Smoking status, cumulative smoking exposure, and smoking intensity were significantly associated with metastasis-free survival (P= .03 for all). High cumulative smoking exposure was independently associated with BCR in both pre- (hazard ratio, 2.23; P= .001) and postoperative (hazard ratio, 1.64; P= .04) multivariable models adjusted for the effects of established clinicopathologic features. Smoking cessation did not affect either BCR- or metastasis-free survival (P= .56 and P= .40, respectively). High cumulative smoking exposure was associated with the biologic and clinical aggressiveness of PCa in patients treated with SRP for radiation-recurrent disease. Smoking is a modifiable risk factor that detrimentally affected the outcomes, even in patients with advanced PCa.

Oncologic impact of cumulative smoking exposure in patients treated with salvage radical prostatectomy for radiation-recurrent prostate cancer

Oncologic impact of cumulative smoking exposure in patients treated with salvage radical prostatectomy for radiation-recurrent prostate cancer

Salvage focal cryosurgery may delay use of androgen deprivation therapy in cryotherapy and radiation recurrent prostate cancer patients

Introduction: Salvage treatment options for recurrent unilateral prostate cancer (PCa) after primary radiation are limited and associated with severe complications and poor quality of life measures. Salvage focal cryotherapy (SFC) has shown success in biochemical recurrence (BCR) free survival. We aim to determine if SFC can delay use of androgen deprivation therapy (ADT) in recurrent PCa with low morbidity.Methods: A retrospective review of patients who underwent SFC at our institution from 2007 to 2015 was performed. Patients with <2 follow-up prostate-specific antigen (PSA) values, metastatic disease, and a history of radical prostatectomy were excluded. Age at treatment, prior treatment history, PSA nadir, complications, BCR status (nadir +2 ng/ml), and follow-up data were obtained/analysed. ADT was commenced if patient experienced BCR and had a PSA doubling time <6 months or positive confirmatory biopsy or positive imaging. Cox regression and survival analysis were used to assess confounding and time to BCR respectively.Results: A total of 65 patients were included and followed for a median of 26.6 (8.0–99.0) months. Thirty-one (47.7%) patients did not experience BCR. An even higher number of patients (52/65, 80.0%) are yet to receive ADT. Of those who experienced BCR [median time to BCR, 17.1 [interquartile range (IQR):11.4–23.3] months], 22/34 (64.7%) are currently carefully monitored without ADT. Survival analysis showed a biochemical recurrence-free survival of 48.1 at 1- and 3-year follow up. No patient died/experienced major complications.Conclusions: SFC may be used to delay the use of ADT. Further assessment of our findings with high-powered studies and longer follow-up is required.

Number of metastatic lymph nodes as determinant of outcome after salvage radical prostatectomy for radiation-recurrent prostate cancer

BackgroundPresence of lymph node metastasis (LNM) at salvage radical prostatectomy (sRP) is associated with poor outcome. Predictors of outcome in this context remain undetermined. The objective was to assess the role of number of positive lymph node on outcome of patients with LNM after sRP and for radio-recurrent prostate cancer. Material and methodsWe analyzed data from a consecutive cohort of 215 men treated with sRP at a single institution. We used univariate Cox proportional hazard regression models for biochemical recurrence (BCR) and metastatic outcomes, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesicle invasion, time between radiation therapy and sRP, and number of positive nodes as predictors. ResultsOf the 47 patients with LNM, 37 developed BCR, 11 developed distant metastasis and 4 died with a median follow-up of 2.3 years for survivors. The risk of metastases increased with higher pre-operative PSA levels (HR 1.19 per 1ng/ml; 95% CI 1.06–1.34; p=0.003). The remaining predictors did not reach conventional levels of significance. However, removal of 3 or more positive lymph nodes demonstrated a positive association, as expected, with metastatic disease (HR 3.44; 95% CI 0.91–13.05; p=0.069) compared to one or 2 positive nodes. Similarly, the presence of extraprostatic extension, seminal vesicle invasion and Gleason grade greater than 7 also demonstrated a positive association with higher risk of metastasis, with hazard ratios of 3.97 (95% CI 0.50, 31.4; p=0.2), 3.72 (95% CI 0.80–17.26; p=0.1), and 1.45 (95% CI 0.44–4.76; p=0.5), respectively. ConclusionsIn patients with LNM after sRP for radio-recurrent prostate cancer, the risk of distant metastasis is likely to be influenced by the number of positive nodes (3 or more), high preoperative PSA, Gleason grade and advanced pathologic stage. These results are consistent with the findings of number of nodes (1 to 2 vs. 3 or more nodes positive) as a prognostic indicator after primary radical prostatectomy and strengthen the plea for a revision of the nodal staging for prostate cancer.

Decision analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

ObjectiveTo determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC).DesignCost-utility analysis using decision analytic modelling by a Markov model.Setting and methodsCompared SC and androgen...

A20 Session 6: Case studies in ablative therapy : Robotic acoustic ablation with HIFU: Technology and clinical outcomes

High Intensity Focused Ultrasound (HIFU) is a minimally invasive technology that produces thermal ablation of soft tissues. HIFU has been employed to treat prostate cancer and transrectal prostate HIFU devices have been in use worldwide since the mid 1990s. Prostate HIFU is not FDA approved in the United States; however, two manufacturers have HIFU devices currently under evaluation in the United States by the FDA. Prostate HIFU has been used to treat primary and radiation recurrent prostate cancer. In this presentation, the Sonablate (Sonacare Medical) and Ablatherm (EDAP) prostate HIFU devices will be compared. Published clinical outcomes for primary and salvage total and partial gland HIFU ablation will be presented. Long term studies document good clinical efficacy with biochemical recurrence, overall survival, and metastasis free survival similar to standard prostate cancer treatments. The advantages of HIFU ablation are similar to other ablation technologies: HIFU is an outpatient, minimally invasive treatment with low rates of ED and incontinence and can be repeated if there is local recurrence. Focal treatment with HIFU is a promising treatment strategy and the use of advanced MRI imaging to diagnose prostate cancer and to direct HIFU ablation will be presented. High patient demand for minimally invasive prostate cancer ablative treatments will inspire urologists interested in thermal ablation to obtain training and achieve competence in prostate HIFU therapy.

Prostate Gland Lengths and Iceball Dimensions Predict Micturition Functional Outcome Following Salvage Prostate Cryotherapy in Men with Radiation Recurrent Prostate Cancer

IntroductionTissue cryoablation is a potential curative option for solid malignancies, including radiation recurrent prostate cancer (RRPC). Case series of salvage cryotherapy (SCT) in RRPC have reported promising disease free survival (DFS) outcomes and acceptable toxicity profile. While many men receive SCT, no predictive factors for treatment induced side effects are known. The aim of this study is to validate the oncologic outcome of SCT in a large multi-centre patient cohort and to identify potential parameters associated with an increased risk of micturition symptoms.Patients and MethodsIn this retrospective analysis, we studied 283 consecutive patients with RRPC treated by SCT in three independent U.K. centres (between 2001 and 2011). Two freeze-thaw cycles of transperineal cryotherapy were performed under transrectal ultrasound guidance by a single surgeon in each of the 3 sites. We analysed clinico-pathological factors against tumour response. Functional outcomes were assessed by continence status and IPSS questionnaire. Predictive factors for SCT-induced micturition symptoms were analysed in a sub-group (n = 42) of consecutive cases.ResultsWe found that nadir post-SCT PSA levels strongly associated with DFS. The DFS rates at 12- and 36-month were 84% and 67% for the ≤1 ng/ml group and 56% and 14% for the >1 ng/ml group, respectively (p<0.001). Correlative analysis revealed highly significant association between patients' post-SCT micturition status with prostate gland and iceball lengths following SCT. Finally, in a reduction model, both gland length and maximal length of iceball were highly associated with patients' IPSS outcome (p<0.001).ConclusionWe report the largest European patient cohort treated with SCT for RRPC. Oncologic outcome guided by nadir PSA of <1 ng/ml is consistent with earlier single-centre series. For the first time, we identified physical parameters to predict micturition symptoms following SCT. Our data will directly assist on-going and future trial design in cryotherapy in prostate cancer.