1218 SALVAGE ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR RECURRENT PROSTATE CANCER: SAFETY AND FEASIBILITY

Abstract

INTRODUCTION AND OBJECTIVES: The safety and feasibility of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer is unclear. Herein we report short-term cancer control, functional, and perioperative outcomes in a multi-institutional cohort. METHODS: Between July 2007 and October 2011, 38 consecutive men underwent sRARP for recurrent prostate cancer at the University of Southern California (n 14) or Global Robotics Institute (n 24). Failed primary therapy was varied (external beam radiotherapy [EBRT; n 14]; interstitial brachytherapy [IBT; n 11]; EBRT IBT [n 5]; high-intensity focused ultrasound [n 3]; cryoablation [n 3]; other [n 2]). The main outcomes were immediate biochemical failure (IBF), positive surgical margins (PSM), urinary continence and erectile function at 3 months, and complications within 90 days of surgery. Immediate biochemical failure was defined as a PSA 0.2 ng/ml. Urinary continence was defined as the use of no pads and erectile function was defined as a SHIM score 21. Complications were classified and graded using the Clavien system. RESULTS: The median age was 68 years (50-83 years) and median preoperative PSA was 4.1 ng/ml (0.4-15.2 ng/ml). Preoperative biopsy Gleason score was 6 (n 7), 7 (n 18), and 8 (n 12). All procedures were completed without the need for open conversion. No patient experienced an intra-operative complication. Median estimated blood loss was 100 ml (30-300 ml) and operative time was 1.5 h (1-6h). Median length of hospital stay was 1 day (1-7 days). The median duration of urethral catheterization was 12 days (4-48 days). IBF occurred in 9 (29%) patients and PSM occurred in 7 (18%) patients. Urinary continence and erectile function occurred in 9 (34%) and 0 patients, respectively. One or more postoperative complications occurred in 12 (31%) patients. Low grade (I-II) and high grade (III-IV) complications occurred in 8 (21%) and 4 (10%) patients, respectively. No patient died. CONCLUSIONS: Salvage robot-assisted radical prostatectomy is safe and feasible. Short-term cancer control and perioperative morbidity were acceptable.