Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes

Abstract

Objective: The objective of this study was to assess the surgical, oncological and short-term functional outcomes in patients undergoing salvage robot-assisted radical prostatectomy (SRARP) for the treatment of radiation-resistant prostate cancer. Patients and Methods: The records of 3,500 men who underwent RARP from February 2006 to July 2011 were retrospectively reviewed. All peri- and postoperative data were recorded prospectively in our database. A total of 13 patients (0.37%) who had undergone SRARP for the treatment of radiation-resistant prostate cancer were identified. Results: The primary treatment was external beam radiotherapy in 7 patients (53.8%) and brachytherapy in 6 patients (46.2%). The interval from radiotherapy to biochemical recurrence (BCR) varied from 12 to 108 months (median 48.9). Neurovascular bundle preservation was performed in 3 patients (23.1%). No intraoperative or major complications were encountered. Minor complications were encountered in 4 patients (30.7%). At 12 months, 7 patients were continent (53.8%), 3 exhibited mild incontinence (23.1%) and 3 (23.1%) were incontinent. Regarding potency, none of the patients were potent at 6 months, but 3 patients (23.1%) were potent at 1 year. Regarding BCR, 3 of the patients (23.1%) never reached a prostate-specific antigen nadir of zero, and during the follow-up period only 3 patients (23.1%) exhibited BCR. No disease-specific mortality was evident during follow-up. Conclusions: Although early in its development, it appears that SRARP is technically feasible and offers satisfactory surgical, oncological and short-term functional outcomes.

Salvage Radical Prostatectomy after External Beam Radiation Therapy: A Systematic Review of Current Approaches

“…The lower reported rates of BL in the last series were caused by the presence in the review of two series of robotic SRP [46,52,53]. The average rates of reported rectal injury, anastomotic stricture, and incontinence were 6.8, 18.3, and 47.8%, respectively.…”

“…Moreover, it is also a ‘land of conquest' for minimally invasive approaches, e.g. robotic SRP [53,54]. …”

Robotic Radical Prostatectomy in Patients with Previous Prostate Surgery and Radiotherapy

“…At 12 months, 7 patients were continent (53.8%), and 3 patients (23.1%) were potent. During the follow-up period, only 3 patients (23.1%) exhibited BCR [31]. …”

Anastomotic leaks and catheter time after salvage robot-assisted radical prostatectomy

“…For example, in the Vanderbilt University cohort that included 34 men who underwent sRARP without the use of the scaffold the rate of anastomotic leak was lower than 15% ( 7 ). Similarly, Yuh et al ( 8 ) and Zugor et al ( 9 ) reported that the proportion of men who experienced anastomotic leaks after sRARP without the use of a scaffolding tissue graft for radio-recurrent PCa did not exceed 20%. This is substantially lower as compared to what reported by Ogaya-Pinies and colleagues in their control group, where more than one out of three patients experienced anastomotic leak after surgery.…”