V4-02: Salvage robotic-assisted laparoscopic prostatectomy (sRARP)
There is a significant cohort of patients who experience recurrent prostate cancer after primary ablative therapy. Salvage robot assisted radical prostatectomy (sRARP) represents a feasible treatment option in these cases. The purpose of the study is to examine the functional and biochemical outcomes in a large series of sRARP performed by a single surgeon (VP).
We retrospectively reviewed our database of more than 6,500 patients who have undergone RARP. Over a period of 8 years (2008-2015) we identified 65 patients who have had sRARP following different types of primary ablative treatment failure. The Kaplan-Meier method was used to estimate survival. Both univariate and multivariate regression analysis were used to determine predictors of biochemical recurrence.
The median interval from primary therapy to sRARP was 48 (range 26-85) months. The median age of patients undergoing sRARP was 69 (65-73) years. The 11 (16.9%) patients had positive surgical margins, 14 (21.6%) extraprostatic extension and 16 (24.6%) seminal vesicle invasion (pT3b). There were no cases of rectal injury or any intraoperative complications. 16 (25%) patients had a biochemical failure after a median follow-up of 16.5 (6-56) months and 10 (15%) required adjuvant hormone therapy. 85% of patients that had sRALP were free of additional therapy at a median of 16.5 months. All 65 patients were continent prior to salvage_x000D_ RARP and 34 (52.3%) of them reported full continence after surgery (no pad used). The 29 (44.6%) of them partial continence1-2 pads and 5 (3.1%) ≥ 3 pads, respectively. 19 (29.2%) patients were considered potent before sRARP and 9 (47.4%) of them retained potency after the sRARP. Tumor stage pT3b (seminal vesicle invasion), pre-op Gleason >7, and positive surgical margins were predictive of biochemical recurrence.
ConOur series supports the feasibility of sRARP as a suitable treatment option for patients who have experienced local recurrence of prostate cancer. Our outcomes for biochemical recurrence, potency, and continence are reasonable, maintaining a reasonable balance between cancer control data, quality of life issues and risk of complications. Longer follow-up will be necessary in determining the full extent of sRARP in providing adequate cancer control and quality of life issues.