The Prostate · 2025
Oncological Outcomes After Robotic Salvage Radical Prostatectomy in Patients Primarily Treated With Focal Versus Radiation Therapy: A Junior ERUS/YAU Collaborative Study.
СтатьяМногоцентровое исследованиеСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wenzel Mike, Nathan Arjun, Covas Moschovas Marcio, Wagner Christian, Calleris Giorgio, Di Maida Fabrizio, Gomez Rivas Juan, Bravi Carlo Andrea, De Groote Ruben, Piramide Federico, Turri Filippo, Kowalczyk Keith, Würnschimmel Christoph, Sharma Gopal, Andras Iulia, Lambert Edward, Liakos Nikolaos, Darlington Danny, Paciotti Marco, Sorce Gabriele, Mandel Philipp, Galfano Antonio, Nathan Senthil, Marra Giancarlo, Dell'Oglio Paolo, Mottrie Alexandre, Chun Felix K H, Patel Vipul, Breda Alberto, Larcher Alessandro
Аннотация
BACKGROUND: To evaluate surgical and cancer-control outcome differences in robotic salvage radical prostatectomy (s-RARP) patients after primary prostate cancer treatment with radiation (RT) versus focal therapy (FT).
METHODS: The Junior ERUS/Young Academic Urologist Working Group Robotics in Urology conducted a multicentric project to investigate biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival outcomes in s-RARP patients primarily treated with RT versus FT.
RESULTS: Overall, 439 s-RARP patients qualified for analyses, of which 54% initially received RT with a median time interval between primary cancer treatment and s-RARP of 48 months. Patients with RT more frequently exhibited unfavorable oncological characteristics before s-RARP (PSA, ISUP score), as well as pathological ISUP score (all ≤ 0.01), relative to FT patients. No differences in postoperative complications were observed (p > 0.9). In BCR-free analyses, no significant differences between RT and FT were observed (hazard ratio [HR]: 1.30, p = 0.2). In MFS and OS analyses, patients with RT harbored a higher risk of metastases (HR: 10.1, p < 0.001) and death (HR: 5.1, p = 0.02), relative to FT s-RARP patients, but not after multivariable adjustment. In subgroup analyses of 201 FT patients, 80% received high-intensified focused ultrasound (HIFU). No difference in BCR-free survival was observed for HIFU- versus non-HIFU s-RARP patients (p = 0.9).
CONCLUSIONS: Important differences in tumor characteristics between RT versus FT s-RARP patients exist. These baseline differences translate into unfavorable short-term MFS- and OS outcomes for RT s-RARP patients.
METHODS: The Junior ERUS/Young Academic Urologist Working Group Robotics in Urology conducted a multicentric project to investigate biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival outcomes in s-RARP patients primarily treated with RT versus FT.
RESULTS: Overall, 439 s-RARP patients qualified for analyses, of which 54% initially received RT with a median time interval between primary cancer treatment and s-RARP of 48 months. Patients with RT more frequently exhibited unfavorable oncological characteristics before s-RARP (PSA, ISUP score), as well as pathological ISUP score (all ≤ 0.01), relative to FT patients. No differences in postoperative complications were observed (p > 0.9). In BCR-free analyses, no significant differences between RT and FT were observed (hazard ratio [HR]: 1.30, p = 0.2). In MFS and OS analyses, patients with RT harbored a higher risk of metastases (HR: 10.1, p < 0.001) and death (HR: 5.1, p = 0.02), relative to FT s-RARP patients, but not after multivariable adjustment. In subgroup analyses of 201 FT patients, 80% received high-intensified focused ultrasound (HIFU). No difference in BCR-free survival was observed for HIFU- versus non-HIFU s-RARP patients (p = 0.9).
CONCLUSIONS: Important differences in tumor characteristics between RT versus FT s-RARP patients exist. These baseline differences translate into unfavorable short-term MFS- and OS outcomes for RT s-RARP patients.