“The rate of locally advanced disease and positive surgical margins after RP in a group of patients with initially low- or intermediate-risk disease is concerning and raises questions that warrant further study. For now, our findings should make urologists aware of the importance of early control biopsies following focal therapy,” Dr. Herrera-Caceres told Urology Times.
Nineteen (56%) of the men had undergone high-intensity focused ultrasound, 13 (38%) had laser ablation, and single patients each underwent cryotherapy or focal brachytherapy. Most of the focal therapy procedures were done with in-bore MRI guidance.
The salvage RP was performed with an open technique in 82% of men. Intraoperatively, cystostomy occurred in two patients, but there were no rectal injuries.
Mean PSA at the time of surgery was 5.38 ng/mL, and nine patients (26%) had persistent PSA postoperatively. No patients died or developed metastases during follow-up after salvage RP. Six patients (18%) received adjuvant radiotherapy, six (18%) received salvage radiotherapy, and four (12%) received androgen deprivation therapy with or without radiotherapy. Nine patients (27%) developed biochemical recurrence at a mean of almost 3 years after salvage RP.
The review of functional outcomes showed 31 patients (91%) were continent, defined as needing ≤1 pad per day. Prior to RP, 58% of patients had some degree of erectile dysfunction and all patients had some degree of erectile dysfunction after the salvage procedure, but 53% were able to have intercourse using medical therapy.
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