Salvage vesiculectomy for local prostate cancer recurrence: surgical technique, complications and early postoperative outcomes

You have accessJournal of UrologyCME1 Apr 2023V10-12 SALVAGE VESICULECTOMY FOR LOCAL PROSTATE CANCER RECURRENCE: SURGICAL TECHNIQUE, COMPLICATIONS AND EARLY POSTOPERATIVE OUTCOMES Alexander Giesen, Thomas Van den Broeck, Dries Develtere, Leuven, Belgium, David Pfister, Stephen Langley, Robert Hente, Marc Claessens, Yannic Raskin, Christopher Eden, Kevin Wymer, R. Jeffrey Karnes, Axel Heidenreich, and Steven Joniau Alexander GiesenAlexander Giesen More articles by this author , Thomas Van den BroeckThomas Van den Broeck More articles by this author , Dries DeveltereDries Develtere More articles by this author , Leuven Leuven More articles by this author , Belgium Belgium More articles by this author , David PfisterDavid Pfister More articles by this author , Stephen LangleyStephen Langley More articles by this author , Robert HenteRobert Hente More articles by this author , Marc ClaessensMarc Claessens More articles by this author , Yannic RaskinYannic Raskin More articles by this author , Christopher EdenChristopher Eden More articles by this author , Kevin WymerKevin Wymer More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , and Steven JoniauSteven Joniau More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003328.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Isolated recurrences of prostate cancer (PCa) have become a more frequent entity with the widespread use of more sensitive imaging modalities. In a growing number of patients, local recurrences in (remnants of) seminal vesicles (SV) emerge. Most of these are within an operated and/or radiated zone, leading to start of androgen-deprivation therapy (ADT) as one of the only options. Salvage vesiculectomy is hypothesized to be a potential curative treatment in these patients. The main objective of this study is to describe this new surgical approach (open and robot-assisted). We further report peri- and postoperative complications and early outcomes. METHODS: This retrospective multicenter study includes 108 patients with solitary recurrence in the SV between January 2009 and June 2022. Patients with local recurrences outside the SV or with concomitant metastatic disease were excluded. Both SV (or the remnants) were resected using an open or a robot-assisted approach. In selected cases, a concomitant lymphadenectomy (LND) was performed. The surgical technique of both approaches is explained in the accompanying video. RESULTS: Our population had a median age of 68 years at the time of surgery with a median pre-operative PSA of 2.7 ng/ml. 74 patients (68.52%) were primary treated with a radical prostatectomy (RP) and 34 patients (31.48%) with radiotherapy (EBRT or brachytherapy). 40% (n=42) of patients had a concomitant LND. There was a median follow-up of 14 months. Up until 90 days after surgery, 28.70% (n=31) had any peri- and/or postoperative complication. These were all but one grade 1 to 3 on the Clavien-Dindo Classification. Most complications occurred within the first month after surgery (n=20). Most were low grade. All complications can be found in Table 1. A median PSA decrease of 2.07 ng/ml (IQR: 0.80-4.33, p<0.001), translating into a median reduction of 92.10% (IQR: 59.34%-98.32%) compared to the pre-operative value is reported. Freedom from secondary treatment was 53.51% at the end of follow-up. CONCLUSIONS: This multicenter, retrospective study shows that salvage vesiculectomy for solitary prostate cancer recurrence limited to the seminal vesicle (remnants) is a generally safe procedure in patients with otherwise limited possibilities other than systemic therapy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e929 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Giesen More articles by this author Thomas Van den Broeck More articles by this author Dries Develtere More articles by this author Leuven More articles by this author Belgium More articles by this author David Pfister More articles by this author Stephen Langley More articles by this author Robert Hente More articles by this author Marc Claessens More articles by this author Yannic Raskin More articles by this author Christopher Eden More articles by this author Kevin Wymer More articles by this author R. Jeffrey Karnes More articles by this author Axel Heidenreich More articles by this author Steven Joniau More articles by this author Expand All Advertisement PDF downloadLoading ...