The aim of this study was to systematically review the current evidence regarding the oncological and functional outcomes of salvage radical prostatectomy (sRP) for recurrent prostate cancer. A systematic review was conducted throughout September 2022 using the PubMed, Science Direct, Scopus, and Embase databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. A total of 55 studies (3836 patients) met our eligibility criteria. The vast majority of men included had radiation therapy (including brachytherapy) as their first-line treatment (n = 3240, 84%). Other first-line treatments included HIFU (n = 338, 9%), electroporation (n = 59, 2%), proton beam therapy (n = 54, 1.5%), cryotherapy (n = 34, 1%), focal vascular targeted photodynamic therapy (n = 22, 0.6%), and transurethral ultrasound ablation (n = 19, 0.5%). Median preoperative PSA, at the time of recurrence, ranged from 1.5 to 14.4 ng/mL. The surgical approach was open in 2300 (60%) cases, robotic in 1465 (38%) cases, and laparoscopic in 71 (2%) cases. Since 2019, there has been a clear increase in robotic versus conventional surgery (1245 versus 525 cases, respectively). The median operative time and blood loss ranged from 80 to 297 min and 75 to 914 mL, respectively. Concomitant lymph node dissection was performed in 2587 cases (79%). The overall complication rate was 34%, with a majority of Clavien grade I or II complications. Clavien ≥ 3 complications ranged from 0 to 64%. Positive surgical margins were noted in 792 cases (32%). The median follow-up ranged from 4.6 to 94 months. Biochemical recurrence after sRP ranged from 8% to 51.5% at 12 months, from 0% to 66% at 22 months, and from 48% to 59% at 60 months. The specific and overall survival rates ranged from 13.4 to 98% and 62 to 100% at 5 years, respectively. Urinary continence was maintained in 52.1% of cases. sRP demonstrated acceptable oncological outcomes. These results, after sRP, are influenced by several factors, and above all by pre-treatment assessment, including imaging, with the development of mpMRI and metabolic imaging. Our results demonstrated that SRP can be considered a suitable treatment option for selected patients, but the level of evidence remains low.
Cancers. 2023 Nov 20*** epublish ***
Amine Saouli, Alain Ruffion, Charles Dariane, Eric Barret, Gaëlle Fiard, Gaelle Fromont Hankard, Gilles Créhange, Guilhem Roubaud, Jean Baptiste Beauval, Laurent Brureau, Raphaëlle Renard-Penna, Mathieu Gauthé, Michael Baboudjian, Guillaume Ploussard, Morgan Rouprêt
Department of Urology, CHU Souss Massa, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir 80000, Morocco., Service D'urologie Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69002 Lyon, France., Department of Urology, Hôpital Européen Georges-Pompidou, AP-HP, Paris University, U1151 Inserm-INEM, F-75015 Paris, France., Department of Urology, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France., Comité de Cancérologie de l'Association Française d'Urologie, Groupe Prostate, Maison de l'Urologie, 11, Rue Viète, 75017 Paris, France., Department of Pathology, CHRU Tours, 37000 Tours, France., Department of Radiotherapy, Institut Curie, 75005 Paris, France., Department of Medical Oncology, Institut Bergonié, 33000 Bordeaux, France., Department of Urology, CHU Rennes, CIC 1414 Rennes, France., AP-HP, Radiology, Pitie-Salpetriere Hospital, Sorbonne University, 75013 Paris, France., Service D'urologie et de Transplantation Rénale, CHU La Conception, 13005 Marseille, France., Department of Urology, La Croix du Sud Hôpital, 31130 Quint-Fonsegrives, France., GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, 75013 Paris, France.