Commentary on Salvage robotic-assisted radical prostatectomy: Initial results and early report of outcomes: Boris RS, Bhandari A, Krane LS, Eun D, Kaul S, Peabody JO, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI

Abstract

To evaluate the initial results of salvage robotic-assisted radical prostatectomy (SRARP) after recurrence following primary radiotherapy (RT) for localized prostate cancer. Between December 2002 and January 2008, 11 patients had SRARP with pelvic lymph node dissection by 1 surgeon from 1 institution. Six patients had brachytherapy, 3 had external beam RT (EBRT), 1 intensity-modulated RT, and 1 received brachytherapy with an EBRT boost. All patients had prostate cancer on biopsy after RT, with negative computed tomography and bone scan. The mean (range) follow-up was 20.5 (1–77) months. The mean interval from RT to SRARP was 53.2 months; the mean preoperative prostate-specific antigen (PSA) level was 5.2 ng/ml, the operative duration 183 minutes, and the estimated blood loss 113 ml. One patient had prolonged lymphatic drainage, 1 had an anastomotic leak, and 1 had an anastomotic stricture requiring direct vision internal urethrotomy at 3 months. The mean duration of catheterization was 10.4 days and the hospital stay 1.4 days. Three patients had a biochemical recurrence, at 1, 2, and 43 months. In 1 of 2 patients with node-positive carcinoma of the prostate the PSA level failed to reach a nadir of 0 after surgery. In patients with a minimum follow-up of 2 months, 8 of 10 are continent (defined as 0 to 1 pad per day) and 2 have erections adequate for intercourse with the use of phosphodiesterase-5 inhibitors. SRARP after RT-resistant disease recurrence is feasible with minimal perioperative morbidity. Early functional outcomes appear to be at least equivalent with historical salvage RP series. Robotic extended pelvic lymph node dissection is safe and can improve the accuracy of surgical staging. A longer follow-up is necessary to better assess the functional and oncologic outcomes.