title: Salvage laparoscopic radical prostatectomy following high-intensity focused ultrasound for treatment of prostate cancer.
abstract: OBJECTIVE
  To test the feasibility and safety of salvage laparoscopic radical prostatectomy (sLRP) for recurrent prostate cancer after high-intensity focused ultrasound (HIFU) treatment.
  
  
  METHODS
  Thirteen men (median age 61.3 years) fulfilled the criteria of recurrent prostate cancer after HIFU undergoing sLRP with HIFU performed using Ablatherm devices (EDAP TMS, Lyon, France). The median interval from primary treatment and biochemical recurrence was 38 months, and the median serum PSA nadir after primary therapy was 1.05 ng\mL. Perioperative data and functional outcome were recorded for each patient. Complications were recorded and graded according to Clavien scale. The prostatectomy specimens were analyzed for Gleason score, extracapsular extension, and surgical margins. Mean follow-up was 14 months.
  
  
  RESULTS
  There was no perioperative mortality and no conversion to open surgery was necessary. Mean operation time was 220 minutes, mean blood loss was 150 mL, and none of the patients received any transfusion. On histopathologic evaluation, 8 patients had extracapsular extension (pT3a) and 5 patients had intracapsular disease (pT2b). Positive surgical margins (PSMs) were detected in 2 patients in the pT3a group. Gleason score was 7 (3 + 4) in 6 patients and (4 + 3) in 5 patients. Two patients had a Gleason score of 8. The median time to achieve continence was 6 months. Four patients showed mild incontinence and used 2 pads per day. None of the patients in our series were potent after sLRP.
  
  
  CONCLUSIONS
  sLRP is feasible for men in whom HIFU has failed but has a higher morbidity rate than primary surgery.
authors.affiliation: Department of Urology, La Sapienza University of Rome, Italy. costantino.leonardo@gmail.com
authors.forename: Costantino
authors.initials: C
authors.lastname: Leonardo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Franco
authors.forename: Cosimo
authors.initials: C
authors.lastname: De Nunzio
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Mariarita
authors.initials: M
authors.lastname: Salvitti
authors.forename: Nicola
authors.initials: N
authors.lastname: Tartaglia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonelli
authors.forename: Carlo
authors.initials: C
authors.lastname: De Dominicis
mesh_terms: D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D036761:Ultrasound, High-Intensity Focused, Transrectal