PD60-08 OUTCOMES OF SALVAGE ROBOTIC-ASSISTED RADICAL PROSTATECTOMY COMPARING PATIENTS WITH PRIMARY FOCAL THERAPY VERSUS WHOLE GLAND ABLATION: A MULTICENTRIC COLLABORATIVE DATA

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You have accessJournal of UrologyCME1 May 2022PD60-08 OUTCOMES OF SALVAGE ROBOTIC-ASSISTED RADICAL PROSTATECTOMY COMPARING PATIENTS WITH PRIMARY FOCAL THERAPY VERSUS WHOLE GLAND ABLATION: A MULTICENTRIC COLLABORATIVE DATA Seetharam Bhat Kulthe Ramesh, Arjun Nathan, Marcio Moschovas, Senthil Nathan, and Vipul Patel Seetharam Bhat Kulthe RameshSeetharam Bhat Kulthe Ramesh More articles by this author , Arjun NathanArjun Nathan More articles by this author , Marcio MoschovasMarcio Moschovas More articles by this author , Senthil NathanSenthil Nathan More articles by this author , and Vipul PatelVipul Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002645.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Introduction With increasing experience, surgeons worldwide have increasingly used Salvage Robotic-assisted Radical Prostatectomy as a tool to treat patients who failed previous non-surgical treatment for prostate cancer. Our study compared the outcomes of salvage radical prostatectomy from two high-volume centers from the US and UK in patients who failed prior treatment with whole gland ablation (SRARP) and focal therapy (fSRARP). METHODS: The study assessed 339 patients compared in two groups: 145 patients who had primary focal therapy and 194 patients who had primary whole gland treatment. SRARP was performed in all cases using a standardized technique developed at respective institutes with the da Vinci Xi Surgical System. Our primary endpoint was the comparison of the functional and oncological outcomes between the groups. RESULTS: The median total operative time for fSRARP was 18 mins higher than SRARP (P <0.001). Significantly higher rates of nerve-sparing was performed in fSRARP (focal vs whole gland; bilateral – 15.2% vs 9.3%; unilateral 49% vs 28.4%; p <0.001). SRARP group had higher rates of ISUP GGp 5 (26.3% vs 19.3%; p <0.001) and deferred ISUP score due to altered pathology (14.8% vs 0.7; p <0.001) while fSRSRP had higher rates of ISUP GGp 4 (11.7% vs 10.7%; p <0.001) and ≥pT3a (64.8% vs 51.6%; p <0.001). Also, fSRARP had higher rates of positive surgical margins (26.2% vs 10.3%; p <0.001). Fig 1 shows a cox regression proportional hazard model for BCR excluding PSA persistence showsa trend towards higher postoperative BCR probability in patients who had SRARP (p= 0.534). Fig 2 shows a cox regression proportional hazard model reporting the probability of postoperative continence shows higher and faster recovery in patients who had fSPARP compared to SRARP (p=0.013). There was no difference in trends of postoperative potency probability in both groups (p=0.997) (Fig 3). CONCLUSIONS: Salvage robotic-assisted radical prostatectomy is challenging wherein patients have adverse pathological features irrespective of primary treatment. Focal therapy group had higher rates of nerve-sparing with increased positive surgical margins. However, both groups had poor functional outcomes regardless of nerve-sparing degree, indicating significant collateral and contralateral damage to tissues surrounding the prostate. We believe that this analysis is crucial for counseling patients regarding expected outcomes before performing a salvage treatment following non surgical local therapy failure. Source of Funding: Nil © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e1028 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seetharam Bhat Kulthe Ramesh More articles by this author Arjun Nathan More articles by this author Marcio Moschovas More articles by this author Senthil Nathan More articles by this author Vipul Patel More articles by this author Expand All Advertisement PDF DownloadLoading ...