Introduction

Salvage radical prostatectomy (sRP) represents a valid treatment option in men with biochemical recurrence (BCR) after primary treatment. Oncological outcomes of Robotic (R) and open (O) approaches have not been compared. We report and compare oncological outcomes of R and OsRP in a large contemporary series.

Methods

Three hundred seventy-six men with BCR, who underwent sRP between 2000 and 2015 at 13 Tertiary referral centres, were retrospectively analysed. Age, PSA, clinical and pathological TNM, primary and pre-sRP biopsy and sRP gleason score (GS), surgical margins, imaging type and positive sites, lymphadenectomy template used, number of lymph-nodes removed and positive, ASA score and ECOG performance status and use of hormonal treatment (HT) were collected for each patient. Exclusion criteria were a follow up <12 months or unavailability of the aforementioned data. Continuous variables were tested for normal distribution and then compared using Wilcoxon-Mann-Whitney test; differences in categorical variables were assessed by Chi-square or Fisher's exact tests.

Results

Two hundred forty-three men were included. Primary treatments were: external beam radiation therapy in 69.5% of patients, cryotherapy in 3.7%, HIFU in 4.1%, brachytherapy in 21.4% and other primary treatments in 1.2% of the patients. No differences were observed regarding: pre-operative PSA (p=0.46), age (p=0.053), ASA score (p=0.06), patients receiving HT (p=0.22) and final pTNM (p=0.91) and mean number of pathologically positive nodes (0.9 ±3.0 in the OsRP vs 0.3 ±1.2 in the RsRP group (p=0.1)). However, before sRP castration resistant prostate cancer (CRPC) was higher in the OsRP group (9.5% vs 1.92%; p=0.01), sRP GS was ≥8 in 42% of OsRP vs 32% of RsRP (p=0.04) and median follow up was longer for OsRP (46.7 months, IQ range 30.2-81.1 vs 27.9 months, IQ range 13.5-44.4, in the RsRP group; p<0.01). Surgical margins were focally or extensively positive in 12.59% and 24.4% of the OsRP group versus 24.7% and 12.38% of the RsRP group (p<0.01). No significant differences were detected in BCR (46.62% of OsRP vs 40.8% of RsRP p=0.4) or progression to CRPC (17.7% of OsRP vs 11.5% of RsRP; p=0.31). OS was higher for RsRP (98% vs 88,9% for OsRP (p<0.01)) and CSS was 98% for RsRP and 94.1% for OsRP (p=0.057).

Conclusions

Promising oncological outcomes can be achieved by salvage radical prostatectomy. The robot-assisted procedure has similar BCR rates compared to the open approach, but can allow lower rates of extensively positive surgical margins and may favour higher OS and CSS trends. To validate the present findings, a longer follow-up and a higher number of patients are needed.

Funding

None