Salvage robot-assisted radical prostatectomy (sRARP) is an acceptable option for men with prostate cancer (PCa) recurrence following primary treatment, according to new study findings.
Gabriel Ogaya‑Pinies, MD, of Hospital Universitario Rey Juan Carlos in Madrid and colleagues studied 96 patients from 2 institutions who underwent sRARP. A majority of these men (70.8%) received radiation treatment as primary therapy, 18.8% cryotherapy, 7.9% high-intensity focal ultrasound (HIFU), and 1% each electroporation, microwave, and Tookad soluble vascular targeted photodynamic therapy.
A quarter of sRARP patients experienced perioperative complications, including 21 minor and 4 major, according to results published in the World Journal of Urology. Anastomotic leak was the most common complication (14.6%). Major complications included 2 urinary leaks requiring Foley catheter reinsertion, 1 myocardial infarction, and 1 lymphocele that needed drainage. No patient had rectal injury.
With regard to functional outcomes, 57.3% of men were pad-free at 12 months. More than half of patients who were potent prior to surgery (Sexual Health Inventory for Men score higher than 21) remained potent with or without the use of a phosphodiesterase type 5 inhibitor at 12 months. The team attributed these outcomes to “meticulous” complete or near complete nerve sparing of the neurovascular bundle using robotic techniques.
Over a median 14 months after surgery, 15% of patients had a biochemical failure.
“sRARP is a feasible alternative for PCa recurrence,” Dr Ogaya‑Pinies and colleagues stated. “Technically the procedure is challenging and should be performed by experienced PCa surgeons. Major complications are uncommon. Continence and potency recovery is possible, but at lower rates than for non-salvage patients.”
Ogaya‑Pinies G, Linares‑Espinos E, Hernandez‑Cardona E, et al. Salvage robotic‑assisted radical prostatectomy: oncologic and functional outcomes from two high‑volume institutions. World J Urol. DOI: 10.1007/s00345-018-2406-4