MP78-16 SALVAGE POSSIBILITIES AFTER FOCAL THERAPY FAILURE: REDO FOCAL TREATMENT VERSUS ROBOTIC RADICAL PROSTATECTOMY ANALYSIS

Abstract

INTRODUCTION AND OBJECTIVES: Focal therapy (FT) for prostate cancer (PCa) presents non-negligible rates of disease recurrence. We aim to assess the outcomes of redoing FT (s-FT) after FT failure as an alternative to radical salvage procedures METHODS: From 2010 to 2018, 37 patients underwent s-FT and 28 patients salvage robotic radical prostatectomy (s-RRP) after focal high-intensity focused ultrasound, cryotherapy or vascular targeted photodynamic therapy. Patients with less than 3 months of follow-up or whole-gland energy salvage treatment were excluded. We also excluded Gleason score (GS) > 7 (4+3) and PSA > 20ng/ml patients aiming to reduce selection bias. Functional outcomes were reported at 3 and 12 months. Urinary incontinence was defined as > 1 daily pads. Complications were registered according to Clavien-Dindo classification. Failure was defined as positive biopsy GS > 7 in s-FT group, PSA > 0.2ng/ml in s-RRP group, need of retreatment, metastasis or PCa-specific death RESULTS: Forty-eight (s-FT: 30 and s-RRP:18) patients were enrolled in the analysis with a median follow-up of 36mo (interquartile range [IQR] 17-53) and 22mo (IQR 6-37); p=0.06 in s-FT and s-RRP groups, respectively. There were no significant differences between the groups regarding age, prostate-specific antigen (PSA), sexual activity or urinary function at baseline. In s-FT and s-RRP groups, GS 6 (3+3) was found in 65.5% and 27.8% and GS 7 (3+4) in 34.5% and 72.2% of patients, respectively (p=0.02). There was no significant difference in complications grade 2 or greater between the groups. Only a patient in s-RRP group presented a grade 3 complication. Failure-free survival in s-FT and s-RRP groups were 96.4% (95% CI 3.5-77.2) and 79.5% (95% CI 10.7-48.3) at 1-yr and 54.2% (95% CI 10.9-31.2) and 47.7% (95% CI 13.9-20.2) at 3-yr, respectively (p=0.27). Only one patient presented PCa-metastasis in s-RRP group. No PCa-specific death was seen in this study. Median ICSmale score was 1 (IQR 0-2) and 9 (IQR 3-12), p<0.001 and median IIEF-5 score was 9 (IQR 3-18) and 1 (IQR 1-9), p=0.007, at 3 months after s-FT and s-RRP, respectively. Enough erection for sexual activity was found in 15 (57.7%) and 0 patients at 3mo, and 13 (72.2%) and 1 (7.1%) at 12mo, p<0.001, respectively. While no patient presented urinary incontinence in s-FT group, it was present in 12 patients (66.6%, p<0.001) at 3mo and in 4 (26.7%, p=0.07) at 12mo (p=0.07) in s-RRP group CONCLUSIONS: A second FT provide acceptable complications and oncological outcomes in short-term, and better functional outcomes in comparison with radical treatment after FT failure.