Salvage radical prostatectomy (SRP) complication rates and functional outcomes are better after primary focal therapy (FT) than after primary radiation therapy (RT) for prostate cancer, investigators reported in The Journal of Urology.
In the study, 95 men had primary FT and 90 men had primary RT (external beam radiation therapy or brachytherapy) followed by SRP. The Clavien-Dindo I-IV complication rate within 30 days was significantly higher in the RT than FT group: 34% vs 5%, respectively, with 19% vs 1%, respectively, experiencing a Clavien-Dindo III a/b complication, Paul Cathcart, MBBS, MD, of Guys and St Thomas NHS Foundation Trust in London, UK and colleagues reported. Continence rates at 12 months were significantly higher in the FT than RT group (83% vs 49% pad-free), whereas potency outcomes were similar (14% FT vs 11% RT).
With respect to oncologic outcomes, the RT group was significantly more likely to have a higher positive surgical margin rate than the FT group: 37% vs 13%. Biochemical recurrence rates at 3 years were 35% FT vs 32% RT. In multivariable analysis, the RT group had a significant 64% lower risk of biochemical recurrence than the FT group. The investigators said they believe all men considering SRP after FT should undergo cross-sectional imaging utilizing, for example, prostate-specific membrane antigen positron emission tomography, to exclude micrometastatic disease.
According to Dr Cathcart’s team, “the functional outcome of SRP is not universally poor and is dependent on primary prostate cancer treatment.” They encouraged urologists managing men with recurrent prostate cancer after FT to consider salvage surgery, in part because RT to the prostate bed is still feasible if SRP is not curative.
In an accompanying editorial, Thomas J. Polascik, MD, of Duke Cancer Institute in Durham, North Carolina, commented: “Overall, this is good news for SRP after FT with less salvage toxicity, but the reader should keep in mind that there are also other salvage options that may have a potentially lower toxicity profile, namely whole gland ablation or salvage RT after FT failure.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Ribeiro L, Stonier T, Stroman L, et al. Is the toxicity of salvage prostatectomy related to the primary prostate cancer therapy received? J Urol. 2021;205:791-799. doi:10.1097/JU.0000000000001382