Findings Support Use of Salvage RALP

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ATLANTA—Salvage robotic-assisted laparoscopic prostatectomy (RALP) for recurrent prostate cancer (PCa) appears to be safe, with outcomes comparable to open salvage radical prostatectomy, according to new findings presented at the American Urological Association 2012 annual meeting.

The primary advantages of salvage RALP are improved visualization of the posterior prostatic plane, low complication rates, and short length of stay, according to investigators who reported on what is possibly the largest single-institution series of salvage RALP.

Samuel D. Kaffenberger, MD, and collaborators, including Kirk A. Keegan, MD, and Joseph A Smith, MD, at Vanderbilt University in Nashville, Tenn., evaluated 34 consecutive patients who underwent salvage RALP from 2006 to mid-2011. Initial therapy was brachytherapy (14 patients), external beam radiotherapy (11 patients), combined brachytherapy/external beam radiotherapy (five patients), and high-intensity focused ultrasound (four patients). All patients had biopsy-proven recurrent PCa and no evidence of metastatic disease.

The median time from primary therapy to salvage treatment was 48.5 months. Subjects had a median PSA level of 3.86 ng/mL prior to salvage treatment. The median operative time was 176 minutes and 94% of patients were discharged on the first post-operative day.

After a median follow-up of 16 months, biochemical failure occurred in 18% of patients and 39% of patients had achieved urinary continence (use of 0-1 pad per day).

Salvage radical prostatectomy, performed in an open or robotic-assisted fashion, is a difficult surgery with a higher rate of potential complications than a prostatectomy performed in the primary setting, Dr. Kaffenberger told Renal & Urology News. However, previous studies have shown that salvage radical prostatectomy can improve survival in patients with locally-recurrent prostate cancer.

“We think that the usage of the robotic platform is the way to go for performance of radical prostatectomy in the salvage setting, especially due to the improved visualization,” Dr. Kaffenberger said. “Our work shows that salvage robotic-assisted radical prostatectomy can be performed safely with excellent early oncologic results, low blood loss, short length of stay, and low rates of bladder-neck contractures. Still, problems with incontinence and erectile dysfunction remain a significant concern in patients undergoing salvage radical prostatectomy.”

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