MP15-16: Validation of EAU recommendation for salvage radical prostatectomy candidates.

Felix Preisser*, Frankfurt , Germany, Christoph Würnschimmel, Randi Marisa Pose, Alexander Heinze, Thomas Steuber, Michl Uwe, Georg Salomon, Hamburg, Germany, Felix K H Chun, Frankfurt , Germany, Markus Graefen, Derya Tilki, Hamburg, Germany

Introduction: The European Association of Urology (EAU) recommends that salvage radical prostatectomy (SRP) should be considered only for patients with favorable tumor characteristics (pre-SRP PSA < 10 ng/mL and biopsy ISUP grade < 2/3). However, it remains uncertain if the original biopsy ISUP or the biopsy ISUP before SRP should be used to select SRP candidates. To investigate the EAU recommendations for SRP and its influence on biochemical recurrence (BCR) after SRP.

Methods: Within a high-volume center database we identified patients who underwent SRP for recurrent prostate cancer (PCa) between 2004 and 2020. Patients were stratified into those who meet EAU recommendations for SRP: pre-SRP PSA < 10 ng/mL and original biopsy ISUP grade < 2/3; and those who didn’t meet EAU recommendations: pre-SRP PSA >= 10 ng/mL or original biopsy ISUP grade >3. Subsequently, a second stratification was performed with the use of the biopsy ISUP before SRP instead of the original biopsy ISUP. Kaplan-Meier analyses and multivariable Cox regression models were used to test the relationship between patients who meet the EAU recommendations and BCR after SRP. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for EAU recommendations to predict BCR.

Results: Overall, 201 patients that underwent SRP were identified.  Of those, 96 vs. 64 meet vs. did not meet the EAU recommendations with the use of the original ISUP. Similarly, 99 vs. 85 meet vs. did not meet the EAU recommendations with the use of the ISUP before SRP. At 60 months BCR-free survival was 70.2 vs. 41.3% (p < 0.01) and 72.5 vs. 44.4% (p < 0.01) for patients that meet vs. did not meet the EAU recommendations with the use of the original ISUP and ISUP before SRP, respectively. In multivariable Cox models, patients who did not meet the EAU recommendations had significant higher risk for BCR with the use of the original biopsy ISUP (Hazard ratio: 2.22, p<0.01) and biopsy ISUP before SRP (Hazard ratio: 1.96, p=0.03). Sensitivity, specificity, PPV, NPV and accuracy was 67.0%, 58.7%, 77.4%, 45.8% and 64.3% vs. 60.2%, 65.4%, 79.1%, 43.0% and 61.8% for the EAU recommendations with the use of the original ISUP vs. the ISUP before SRP to predict development of BCR after SRP.

Conclusions: Patients that fulfill the EAU recommendations for SRP have favorable BCR-free survival compared to patients that do not fulfill these criteria, regardless of the original ISUP or the ISUP before SRP. Further studies are warrant to test if these criteria are useful to predict long-term oncologic outcomes.

Source of Funding: None