Login to Access Video or Poster Abstract: MP47-07
Sources of Funding: None

Introduction

Recurrent prostate cancer (PCa) will occur in approximately 25% of cases after primary radiotherapy (RT) and other ablative techniques. While no consensus on the optimal salvage treatment exists, only 3% of these patients will get salvage radical prostatectomy due to the assumed technical challenges of this procedure._x000D_ We aimed to analyze the perioperative, oncologic and functional outcomes of patients undergoing salvage robotic-assisted radical prostatectomy (sRARP) after primary treatment failure, at two high-volume institutions._x000D_

Methods

Data was prospectively collected and retrospectively reviewed from a combined database of more than 14,800 patients who have undergone RARP. Between 2008-2016, we identified 96 patients who underwent sRARP after RT or ablative techniques. PCa recurrence was biopsy-proven in all cases. We analyzed primary cancer characteristics, surgical data, pathology results, perioperative complications, and oncologic and functional outcomes.

Results

Sixty-four patients (66.6%) were treated primarily with RT: 37 with External Beam RT (EBRT), 14 with Brachytherapy and 13 with EBRT + Brachytherapy. Eighteen patients (18.8%) received cryotherapy as their primary treatment, while 7 patients (7.3%) received HIFU. The remaining seven patients received treatment with either: Cyberknife, electroporation or microwaves._x000D_ The median surgical time was 128.47 min (98181). Sixteen patients (16.7%) had positive surgical margins, 46 (47.9%) show extraprostatic extension with 22 of them (23%), seminal vesicles invasion (pT3b). Complications were seen in 25 (26%) patients (21 minor and 4 major complications). Anastomotic leak was the most common complication, found in 14 (14.6%) of the cases. No rectal injuries ocurred. Fourteen (15%) patients had a biochemical failure after a median follow-up of 14(IQR 5-24) months. All 96 patients were continent prior to sRARP. Sixty-eight patients (71%) had social continence (0-1pad) and 55 (57%) of them self-reported to be pad free at 12 months, while 13 (13.5%) of them reported to be using 1pad/day. Seventeen(55%) of 31 preoperative potent patients (SHIM score >21), were potent with or without the use of PDE5i at 12 months._x000D_

Conclusions

sRARP is a feasible alternative for PCa recurrence after ablative and radiation therapies. Rectal injuries are uncommon. Technically the procedure is challenging and should be performed by experienced prostate cancer surgeons. Continence and potency recovery is possible but at lower rates than for non-salvage patients. Patients should be counseled regarding the risks and benefits of salvage RARP.

Funding

None