Robotic radical prostatectomy is feasible after primary treatment failure

30.07.2018

Robot-assisted radical prostatectomy (sRARP) is a good option for men with prostate cancer recurrence following primary treatment.

In a recent study, 96 patients underwent sRARP after primary treatment for prostate cancer. A majority of these men (70.8%) previously received radiation treatment, 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. 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 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.

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.

Reference

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

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