Comparative analysis of robot-assisted and open approach for PSMA-radioguided surgery in recurrent prostate cancer

Abstract

Purpose To compare the oncological and surgical outcomes of patients with recurrent prostate cancer (PCa) who underwent either open or newly established robot-assisted salvage prostate-specific membrane antigen–radioguided surgery (PSMA-RGS). Materials and methods Patients who consecutively underwent PSMA-RGS for PCa recurrence between January 2021 and December 2022 were identified. The rate of complete biochemical response, biochemical recurrence-free survival [BFS], and the rate of salvage therapy were evaluated. Univariable and multivariable regression models tested the association between the surgical approach and surgical outcomes. Results Overall, 85 patients were selected, with 61 patients (72%) undergoing open PSMA-RGS and 24 patients (28%) receiving a robot-assisted approach. The oncological outcomes of the two groups were comparable (12-month BFS: 41% (Confidence interval (CI): 29–58%) vs. 39% (CI: 19–79%), p = 0.9, respectively). According to multivariable regression models, the robotic approach did not significantly influence estimated blood loss (EBL) (β = −40, 95% CI: −103, 22; p = 0.2) and significantly increased operative time (OT) (β = 28, 95% CI: 10, 46; p = 0.002). No Clavien-Dindo III–V complications were reported in the robotic group. Conclusion Both, the open as well as the robot-assisted approach for PSMA-RGS had comparable oncological outcomes. No safety concerns arose for the robotic-assisted approach offering a potentially improved quality of life for patients.

Limited prognostic role of routine serum markers (AP, CEA, LDH and NSE) in oligorecurrent prostate cancer patients undergoing PSMA-radioguided surgery

“…In recent years, the widespread use of PSMA PET in both, staging and restaging, has sparked a strong interest in targeted imaging and individualized treatment strategies [ 1 , 18 ]. This is particularly evident for open or robot-assisted PSMA-RGS as a patient-specific salvage treatment for PCa recurrence [ 19 ]. This technique has proven to be oncologically safe, as it effectively delays the start of systemic treatment in selected patients [ 7 ].…”

“…In general, the literature exploring the role of biomarkers in oncologic outcomes of PCa is controversial. AP is one of the most widely studied markers which was found to be associated with OS and the risk of disease progression, but not with cancer-specific mortality in both, low and high volume metastatic HSPC [ 14 , 19 ]. Nevertheless, Tsuzuki et al developed a prognostic model including Gleason pattern 5, AP and LDH as predictors for a shorter time to CRPC and thus a poorer prognosis among patients with low-volume HSPC [ 21 ].…”

Prostate-specific membrane antigen-targeted surgery in prostate cancer: Accurate identification, real-time diagnosis, and precise resection

“…Although sentinel PLND can detect micro-LNMs, its non-targeting nature may limit its further use, especially in patients with recurrent PCa whose lymphatic drainage has been altered by previous PLNDs. Recently, Maurer et al performed a systematic comparative analysis between robot-assisted and open salvage PSMA-RGS, proving the safety and efficiency of robot-assisted PSMA-RGS with a longer operating time and equal estimated blood loss 42 . Complete biochemical response (cBR, PSA < 0.2 ng/mL 2-16 weeks after PSMA-RGS) was 57% (34/61) in the open group and 61% (14/24) in the robotic group 42 .…”

“…Recently, Maurer et al performed a systematic comparative analysis between robot-assisted and open salvage PSMA-RGS, proving the safety and efficiency of robot-assisted PSMA-RGS with a longer operating time and equal estimated blood loss 42 . Complete biochemical response (cBR, PSA < 0.2 ng/mL 2-16 weeks after PSMA-RGS) was 57% (34/61) in the open group and 61% (14/24) in the robotic group 42 . The same research group further studied the reasons for negative histopathology from PSMA-RGS in 302 patients with recurrent PCa, showing that false positive lesions on PSMA-PET in most cases had negative histopathology and that only a few true-positive lymph nodes were missed by surgery 43 .…”

“…For PSMA-targeted RGS, both robot-assisted and open surgeries are appropriate for patients with recurrent PCa. Ambrosini et al compared 24 patients (28%) undergoing robot-assisted RGS with 61 patients (72%) receiving open PSMA-RGS and found that they had comparable oncological outcomes with no safety concerns 42 .…”