Feasibility and Oncologic Outcome of Salvage Surgery in Isolated Seminal Vesicle Remnants after Radical Prostatectomy.
68Ga prostate-specific membrane antigen positron emission tomography
Local recurrence
Prostate cancer
Seminal vesicle
Journal
Urologia internationalis
ISSN: 1423-0399
Titre abrégé: Urol Int
Pays: Switzerland
ID NLM: 0417373
Informations de publication
Date de publication:
2022
2022
Historique:
received:
16
10
2020
accepted:
22
12
2020
pubmed:
8
4
2021
medline:
4
3
2022
entrez:
7
4
2021
Statut:
ppublish
Résumé
To demonstrate the feasibility of resecting isolated locally relapsing seminal vesicle remnants after primary radical prostatectomy and radiotherapy. Early oncologic outcomes and prognostic risk factors for relapse are demonstrated. A total of 32 patients underwent open resection of locoregional prostate cancer recurrence in seminal vesicles, as documented on either MRI, 11C-choline, or 68Ga-PSMA PET/CT scans. Age, PSA-DT, PSA, and time to recurrence after primary treatment resection status were used in a uni- and multivariate Cox regression analysis for biochemical relapse after surgery. Median patient age at time of salvage surgery was 70 (57-77) years. Median PSA and PSA-DT was 2.79 (0.4-61.54) ng/mL and 5.4 (1.6-20.1) months, respectively. Median surgical time and hospital stay was 132 (75-313) min and 5.5 (4-13) days, respectively. After a mean follow-up of 29 (2-92) months, 3 patients died at 8, 14, and 40 months after salvage surgery, and 6 (18.75%) patients remain without biochemical relapse and further treatment. Median progression-free survival was 12 (1-81) months. In the univariable Cox regression analysis, age at time of surgery, preoperative PSA, and the time from primary treatment to salvage surgery were identified as significant parameters for biochemical relapse. Only the interval from primary to salvage surgery was significant in the multivariate analysis with a hazard ratio of 1.008 (95% CI: 1.001-1.015, p = 0.018). In the entire cohort, 4 adjunctive surgeries (3 ureteroneocystostomies and 1 nephrectomy) were needed due to local progressive disease. Seminal vesicle resection is feasible with no significant intra- or postoperative complications. Almost all patients progressed to biochemical or systemic relapse. Salvage surgery must be seen as a preventive for local symptoms, in our experience most often postrenal ipsilateral obstruction.
Sections du résumé
BACKGROUND
BACKGROUND
To demonstrate the feasibility of resecting isolated locally relapsing seminal vesicle remnants after primary radical prostatectomy and radiotherapy. Early oncologic outcomes and prognostic risk factors for relapse are demonstrated.
OBJECTIVES AND METHODS
OBJECTIVE
A total of 32 patients underwent open resection of locoregional prostate cancer recurrence in seminal vesicles, as documented on either MRI, 11C-choline, or 68Ga-PSMA PET/CT scans. Age, PSA-DT, PSA, and time to recurrence after primary treatment resection status were used in a uni- and multivariate Cox regression analysis for biochemical relapse after surgery.
RESULTS
RESULTS
Median patient age at time of salvage surgery was 70 (57-77) years. Median PSA and PSA-DT was 2.79 (0.4-61.54) ng/mL and 5.4 (1.6-20.1) months, respectively. Median surgical time and hospital stay was 132 (75-313) min and 5.5 (4-13) days, respectively. After a mean follow-up of 29 (2-92) months, 3 patients died at 8, 14, and 40 months after salvage surgery, and 6 (18.75%) patients remain without biochemical relapse and further treatment. Median progression-free survival was 12 (1-81) months. In the univariable Cox regression analysis, age at time of surgery, preoperative PSA, and the time from primary treatment to salvage surgery were identified as significant parameters for biochemical relapse. Only the interval from primary to salvage surgery was significant in the multivariate analysis with a hazard ratio of 1.008 (95% CI: 1.001-1.015, p = 0.018). In the entire cohort, 4 adjunctive surgeries (3 ureteroneocystostomies and 1 nephrectomy) were needed due to local progressive disease.
CONCLUSION
CONCLUSIONS
Seminal vesicle resection is feasible with no significant intra- or postoperative complications. Almost all patients progressed to biochemical or systemic relapse. Salvage surgery must be seen as a preventive for local symptoms, in our experience most often postrenal ipsilateral obstruction.
Identifiants
pubmed: 33827096
pii: 000514054
doi: 10.1159/000514054
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
44-50Informations de copyright
© 2021 S. Karger AG, Basel.