LAUSR

INTRODUCTION AND OBJECTIVE: RSP represents a secondary local treatment option with curative intent in men with rPCA. Even nowadays the majority of men with rPCA is treated conservatively due to anticipated surgery associated complications and suboptimal oncological outcome. It is the purpose to evaluate functional and oncological outcome in a large series of contemporary RSP performed in 3 tertiary referral centres. METHODS: 536 patients with biopsy proven rPCA underwent open retropubic RSP and pelvic lymphadenectomy. Median age was 67.5 (42-79) years and median PSA serum concentration prior to RSP was 4.93 (0,9-41,9) ng/ml. Uniand multivariate analysis were performed to identify risk factors associated with progression-free (PFS) and overall survival (OS). Perioperative complications were assessed to Clavien-Dindo classification. RESULTS: RSPs were performed by 4 surgeons only. IMRT ADT, LDRand HDR brachytherapy were performed in 66.4%, 26.7%, and 6.9%, resp. Following RSP 46.6% pts exhibited organ confined disease whereas 18.0%, 33.9% and 1.4% demonstrated pT3a, pT3b, and pT4 rPCA, resp. Lymph node metastases were identified in 31.2% and positive surgical margins were present in 27.2%. LNM correlated with increasing pT stage and were found in 9.2% of pT2 and 35.3% pf pT3b pts. Biochemical relapse-free survival was 58.2% for the total cohort and 76.4%, 70.8% and 62.1% for pts with pT2, pT3a, and pT3b rPCA. PFS for men with LNM was 22.5%. The median followup was 45.1 (4-105) months and OS was 89.2%. Presence of LNM with HR of 0.32 (95%CI 0.164-0.626; P<0.001), hormonal treatment HR of 0.274 (95%CI 0.117-0.640; p[0.003) and pT3b with HR 0.44 (95%CI 0.12-0.894, p[0.04) correlated with PFS. Grad III & IV complications developed in 16,8% of pts. None of the pts experienced grade V complications. Complete continence was achieved in 62.3% and 26.5% and 11.9% moderate (1-2 pads/day) or severe incontinence, resp. CONCLUSIONS: RSP for rPCA results in excellent PFS and OS for patients with pT2/pT3a pN0 disease in tertiary referral centres with high surgical expertise. Surgery associated morbidity is minimal and frequency of severe incontinence with the need for placement of an artificial urinary sphincter is low. RSP remains a relevant second line treatment with curative intent for rPCA and it needs to be considered more often.