Recurrent Gleason score 6 prostate cancer after radiotherapy or ablation: Should we observe them all? Results from a large multicenter salvage radical prostatectomy consortium Journal Article
| Authors: | Marra, G.; Calleris, G.; Conte, F.; Benfant, N.; Rajwa, P.; Ahmed, M.; Abreu, A.; Cacciamani, G.; Smith, J. A.; Joniau, S.; Rodriguez-Sanchez, L.; Sanchez-Salas, R.; Cathcart, P.; Gill, I.; Karnes, R. J.; Tilki, D.; Shariat, S. F.; Touijer, K.; Gontero, P. |
| Article Title: | Recurrent Gleason score 6 prostate cancer after radiotherapy or ablation: Should we observe them all? Results from a large multicenter salvage radical prostatectomy consortium |
| Abstract: | Background: Salvage radical prostatectomy (sRP) yields poor functional outcomes and relatively high complication rates. Gleason score (GS) 6 prostate cancer (PCa) has genetic and clinical features showing little, if not absent, metastatic potential. However, the behavior of GS 6 PCa recurring after previous PCa treatment including radiotherapy and/or ablation has not been investigated. Objective: To evaluate the oncological outcomes of sRP for radio- and/or ablation-recurrent GS 6 PCa. Design, setting, and participants: Retrospective data of sRP for recurrent PCa after local nonsurgical treatment were collected from 14 tertiary referral centers from 2000 to 2021. Intervention: Prostate biopsy before sRP and sRP. Outcome measurements and statistical analysis: A survival analysis was performed for pre-sRP biopsy and sRP-proven GS 6. Concordance between PCa at pre-sRP biopsy and sRP histology was assessed. Results and limitations: We included GS 6 recurrent PCa at pre-sRP biopsy (n = 142) and at sRP (n = 50), as two cohorts. The majority had primary radiotherapy and/or brachytherapy (83.8% of GS 6 patients at pre-sRP biopsy; 78% of GS 6 patients at sRP) and whole-gland treatments (91% biopsy; 85.1% sRP). Biopsy GS 6 10-yr metastasis, cancer-specific survival (CSS), and overall survival (OS) were 79% (95% confidence interval [CI] 61–89%), 98% (95–99%), and 89% (78–95%), respectively. Upgrading at sRP was 69%, 35.5% had a pT3 stage, and 13.4% had positive nodes. The sRP GS 6 10-yr metastasis-free survival, CSS, and OS were 100%, 100%, and 90% (95% CI 58–98%) respectively; pT3 and pN1 disease were found in 12% and 0%, respectively. Overall complications, high-grade complications, and severe incontinence were experienced by >50%, >10%, and >15% of men, respectively (in both the biopsy and the sRP cohorts). Limitations include the retrospective nature of the study and absence of a centralized pathological review. Conclusions: GS 6 sRP–proven PCa recurring after nonsurgical primary treatment has almost no metastatic potential, while patients experience relevant morbidity of the procedure. However, a significant proportion of GS 6 cases at pre-sRP biopsy are upgraded at sRP. In the idea not to overtreat, efforts should be made to improve the diagnostic accuracy of pre-sRP biopsy. Patient summary: We investigated the oncological results of salvage radical prostatectomy for recurrent prostate cancer of Gleason score (GS) 6 category. We found a very low malignant potential of GS 6 confirmed at salvage radical prostatectomy despite surgical complications being relatively high. Nonetheless, biopsy GS 6 was frequently upgraded and had less optimal oncological control. Overtreatment for recurrent GS 6 after nonsurgical first-line treatment should be avoided, and efforts should be made to increase the diagnostic accuracy of biopsies for recurrent disease. © 2023 The Author(s) |
| Keywords: | adult; human tissue; survival analysis; cancer surgery; major clinical study; overall survival; histopathology; cancer recurrence; cancer radiotherapy; diagnostic accuracy; morbidity; recurrence; retrospective study; prostate cancer; gleason score; prostatectomy; cancer specific survival; multicenter study; prostate biopsy; brachytherapy; radical prostatectomy; salvage radical prostatectomy; metastasis free survival; charlson comorbidity index; human; male; article; tertiary care center; gleason score 6 |
| Journal Title: | European Urology Focus |
| Volume: | 10 |
| Issue: | 3 |
| ISSN: | 2405-4569 |
| Publisher: | Elsevier B.V. |
| Date Published: | 2024-05-01 |
| Start Page: | 461 |
| End Page: | 468 |
| Language: | English |
| DOI: | 10.1016/j.euf.2023.08.007 |
| PUBMED: | 37704503 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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