MP54-19\u2003REFINING PATIENT SELECTION FOR SALVAGE RADICAL PROSTATECTOMY: EAU GUIDELINES-COMPLIANT PATIENTS SHOW BETTER OUTCOMES

Abstract

INTRODUCTION AND OBJECTIVES: A curative option in men with biochemical recurrence (BCR) after primary treatment is represented by salvage radical prostatectomy (sRP). To enhance cancer control and benefit-risk ratio, patient selection is definitely the key. According to EAU guidelines, sRP candidates should have low comorbidities, pre-sRP PSA <10 ng/mL, pre-sRP biopsy Gleason Score (GS) ⩽ 8, no evidence of lymph-node or extra-nodal metastases and previous organ-confined disease. We compared histological and oncological outcomes between patients compliant and non-compliant with these requirements. METHODS: Seventy-three full-EAU-compliant (lower-risk, Group A) and 236 non-EAU-compliant patients (higher risk, group B) were retrospectively enrolled, drawing from a database of 615 sRP performed between 2000 and 2016 at 18 tertiary referral centres. We assessed pre-, intra and post-procedural clinical and histological data. A follow up <6 months or unavailability of the data were exclusion criteria. Continuous variables were compared using Wilcoxon-Mann-Whitney test; differences in categorical variables were assessed by Chi-square or Fisher s exact tests. RESULTS: No significant difference between Group A and B was observed as for median age at sRP (65.57 vs 66.91 years, p=0,11) and follow-up duration (3.43 vs 3.12 years, p=0,16). As obvious, PSA before salvage surgery was significantly higher among Group B patients (5.0 [IQR: 2.5-5.4] vs 3.8 [IQR 2.6 vs 9.0] ng/ml, p=0,01), as well as ASA score and GS distribution at confirmatory biopsy. Organ-confined disease at sRP (pT2) was encountered in 68.5% vs 35.9% (p<0,01), pN1 disease in 7.8% vs 23.5% (p<0,01) and of GS≥8 disease in 8.8% vs 56.1% (p<0,01), of men belonging to Group A vs Group B, respectively. In the higher risk group, positive surgical margins were more common (43% vs 27%, p=0,02). Lower-risk group showed a nearly doubled BCR-free survival at last follow-up (64.4% vs 37.9%, p>0,01). Besides, proportions of patients alive at last follow-up were similar: 94,5% vs 93,6% for Group A vs B, respectively. CONCLUSIONS: For well-selected patients affected by recurrent PCa after non-surgical treatment, sRP entails promising short-term oncological outcomes, along with considerable morbidity. More than the half (64.4%) of men fully-compliant to EAU selection criteria is still disease-free 3 years after sRP. These data suggest that potentially-curative surgical salvage treatment should not be precluded upfront. Large long-term series are needed to confirm sRP benefits and to improve patient selection. Source of Funding: None