Data from a very small study carried out by an Italian clinical research team has demonstrated exactly what one might expect … that salvage surgery can certainly be carried out for men in whom high-intensity focused ultrasound (HIFU) has failed, but that such salvage surgery comes with a higher morbidity rate than primary surgery.
Leonardo et al. set out to test whether (non-robot-assisted) laparoscopic radical prostatectomy (LRP) was a feasible and safe method of treatment for men with recurrent prostate cancer after initial HIFU treatment.
They report on the treatment of a series of 13 patients who fulfilled their criteria for recurrent disease after first-line treatment with HIFU using the Ablatherm technology. Perioperative data and functional outcomes were recorded for all patients; complications of surgical treatment were recorded and graded according to Clavien scale; and prostatectomy specimens were analyzed for Gleason score, extracapsular extension, and surgical margins.
Here are the results that they report:
- The average (median) nadir serum PSA level of the 13 patients after primary HIFU was 1.05 ng/ml.
- The average (median) time interval from primary HIFU treatment to biochemical recurrence was 38 months.
- The average (median) age of the patients was 61.3 years.
- The average (mean) follow-up post-surgery was 14 months.
- There was no perioperative mortality.
- No patients required conversion from LRP to open surgery.
- The average (mean) time e for the operation was 220 minutes.
- The average (mean) blood loss was 150 ml. (No patients required or received any transfusion.)
- 8/13 patients (62 percent) had extracapsular extension (pT3a).
- Positive surgical margins (PSMs) were detected in 2/8 patients (25 percent) with pT3a disease
- 5/13 patients had organ-confined prostate cancer (pT2b).
- Gleason scores of 7 were noted in 11/13 patients.
- 6/11 men had a Gleason score of 3 + 4
- 5/11 men had a Gleason score of 4 + 3
- Gleason scores of 8 were noted in 2/13 patients.
- The average (median) time to achievement of continence was 6 months.
- 4/13 men showed mild incontinence and were still using 2 pads/day after 14 months of follow-up.
- 0/13 patients in this series were potent after salvage LRP.