title: Minimally Invasive Salvage Prostatectomy After Primary Radiation or Ablation Treatment.
abstract: OBJECTIVE
  To analyze oncologic, functional and morbidity outcomes for patients undergoing minimally invasive salvage prostatectomy (MISP) at our institution.
  
  
  METHODS
  Between 2001 and 2015, 5841 patients underwent radical prostatectomy at our institution, out of which 28 were MISP. Indications for MISP were prostate-specific antigen nadir +2 ng/dL in radio-recurrent patients and biopsy-proven prostate cancer (PCa) in other ablative treatments. We analyzed primary cancer characteristics, surgical data, perioperative complications, oncologic and functional outcomes of MISP, and further compared results between MISP after primary whole-gland treatment (WT) and focal treatment (FT).
  
  
  RESULTS
  Median age at salvage treatment was 65 (interquartile range [IQR] 61-68). Compared with WT, MISP after FT had significantly lower operative time (133 vs 176 min, P = .001) and fewer upstaging (≥pT3a) (28% vs 79%, P = .008) at final pathology. Overall, positive surgical margin (PSM) were noted in 4 patients (14%). Perioperative complications were observed in 9 patients with no difference between groups. At 12-months follow-up, 57% were continent and 33% had moderate to severe urinary leak. Potency was preserved in 6 out of 10 preoperatively potent patients. Over a median follow-up of 62 months (IQR 43-110), 11 patients relapsed with a median time to biochemical recurrence of 16 months (IQR 7-25). Recurrences were managed with salvage radiotherapy in 6 patients, 4 with hormone therapy and 1 castration-resistant prostate cancer. Overall, 24 patients are alive at last follow-up and 18 (72%) remain disease free.
  
  
  CONCLUSIONS
  MISP after primary radiation or ablation for prostate cancer is feasible and safe with acceptable oncological outcomes. Compared with FT, MISP after WT appears to have longer operative time and more frequent upstaging.
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Estefania
authors.initials: E
authors.lastname: Linares Espinós
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France. Electronic address: rafael.sanchez-salas@imm.fr.
authors.forename: Rafael
authors.initials: R
authors.lastname: Sánchez-Salas
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Arjun
authors.initials: A
authors.lastname: Sivaraman
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Jose I
authors.initials: JI
authors.lastname: Perez-Reggeti
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Barret
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Rozet
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Galiano
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Prapotnich
authors.affiliation: Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cathelineau
mesh_terms: D055011:Ablation Techniques; D000368:Aged; D003131:Combined Modality Therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome