JCU - January 2022 - 32

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Journal of Clinical Urology 15(1)
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Failure of Salvage Treatment for Delayed
BCR Kaplain-Meier Survival Graph
Figure 3. (a) Kaplan-Meier curves for failed salvage treatment in all patients with biochemical recurrence (BCR) according to
treatment modality; (b) Kaplan-Meier curves for failed salvage treatment according to treatment modality in patients with an
immediate BCR. Including log-rank statistical analyses of the effectiveness of different modalities; (c) Kaplan-Meier curves for failed
salvage treatment according to treatment modality in patients with a delayed BCR. Log-rank statistical analyses did not demonstrate
any difference between the curves.
It is well known that functional outcomes in terms of
incontinence and ED vary widely following surgery for
CaP.17 There are issues with poor levels of reporting, lack of
precise definitions, adequate preoperative assessment and
both over and underestimation of severity by both clinicians
and patients.27,28 However, functional outcomes are an essential
survivorship consideration and can have a significant
effect on quality of life.29 Functional outcome assessment for
the present cohort arises from the previously used BAUS
complex dataset assessment. Information was available on
the majority of patients (79.5%) and was taken beyond 12
months postoperatively; 79.8% were either continent or
reporting minor stress leakage; 7.5% were using more than
one pad per day and 3.2% were using an appliance. Three
patients from the cohort had an artificial urinary sphincter
inserted (<0.5%). In terms of erectile function, the present
data show that 85% of patients reported full ED. However,
these rates are well recognised in high-risk patients due to
poor preoperative function and the wide dissection required
in such patients.30 They are comparable to radiotherapy for
clinical T3 disease,31 and are in keeping with previous reports
in high-risk patients documenting continence and ED rates
of 32-96.2% and 60-64%, respectively.26,30
Despite concerns regarding oncological outcomes, the
present study reveals excellent OS, CSS and biochemical
progression-free survival of 94.3%, 98.7% and 46.7%,
respectively, with a median follow-up of 5.5 years (see
Figure 1). However, these rates are not unique and fall
within ranges recently reported following surgery in such
patients: OS 73.6-98.6%; CSS 89.8-100%; BCR 32-94%.27
The OS and CSS rates seen here are at the upper end of the
ranges seen, despite the fact that this cohort represents a
truly high-risk group of patients as compared to those
defined on preoperative parameters. As with previous surgical
series the BCR rates in the present study are significant.
We would suggest that this is due to the fact that BCR is
defined as any detectable PSA in the present paper and secondly
by the presence of occult micrometastatic disease at
diagnosis in many of these patients. The authors believe that
this PSA level for BCR is appropriate (rather than the widely
held definition of ⩾0.3 ng/ml) as patients are not only
referred for, but also receive, salvage treatments at PSA levels
less than 0.3 ng/ml.32 Occult micrometastatic disease,
which is evident with an immediately detectable postoperative
PSA, is a product of staging performance. Unfortunately,
routine staging techniques including choline positron emission
tomography (PET) scanning do not reliably detect
lymph node involvement or distant bony or visceral metastases.33
In addition, more contemporary techniques such as
prostate-specific membrane antigen (PSMA) PET perform
better than choline PET scanning, but still fail to identify all
metastatic sites reliably.34

JCU - January 2022

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Contents
JCU - January 2022 - Cover1
JCU - January 2022 - Contents
JCU - January 2022 - 2
JCU - January 2022 - 3
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JCU - January 2022 - Cover3
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