Salvage robotic-assisted laparoscopic prostatectomy (SRARP)

INTRODUCTION & OBJECTIVES: 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 (VRP). MATERIAL & METHODS: 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. RESULTS: 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 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. Tumour stage pT3b (seminal vesicle invasion), pre-op Gleason >7, and positive surgical margins were predictive of biochemical recurrence. CONCLUSIONS: Our 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.