Salvage Robot-assisted Radical Research Articles

The Contemporary Role of Salvage Radical Prostatectomy in the Management of Recurrent Prostate Cancer: An Up-to-Date Review.

Prostate cancer is the second most common cancer among men, with many treatment modalities available for patients, such as radical prostatectomy, external beam radiotherapy, brachytherapy, high-intensity focused ultrasound, cryotherapy, electroporation and other whole-gland or focal ablative novel techniques. Unfortunately, up to 60% of men with prostate cancer experience recurrence at 5 to 10 years. Salvage radical prostatectomy can be offered as an option in the setting of recurrence after a primary non-surgical treatment. However, the complexity of salvage radical prostatectomy is considered to be greater than that of primary surgery, making it the least popular treatment of choice. With the wide use of robotic platforms in urologic oncologic surgery, salvage radical prostatectomy has attracted attention again because, compared to past data, modern series involving salvage Robot-Assisted Radical Prostatectomy have shown promising results. In this narrative literature review, we comprehensively examined data on salvage radical prostatectomy. We investigated the correlation between the different types of primary prostate cancer therapy and the following salvage radical prostatectomy. Furthermore, we explored the concept of a robotic approach and its beneficial effect in salvage surgery. Lastly, we emphasized several promising avenues for future research in this field.

Salvage robot-assisted radical prostatectomy after carbon ion radiotherapy to the prostate.

This study presents the surgical and oncological outcomes of salvage robot-assisted radical prostatectomy (RARP) after carbon ion radiotherapy at a single institution. Patients who underwent salvage RARP for local recurrence after carbon ion radiotherapy at Kyushu University Hospital between 2020 and 2023 were included. A single surgeon performed salvage RARP with extended pelvic lymph node dissection. Clinicopathological characteristics and perioperative and postoperative outcomes were prospectively collected and electronically recorded. Ten cases were included. The preoperative clinical T-stage was T2, except for one case with T3a. The median console time was 171 min (range, 135-226 min). No severe perioperative or postoperative complications were noted. The pathological T-stage was T2, T3a, and T3b in four, four, and two cases, respectively. Biochemical recurrence was observed in one patient at 31.2 months after surgery. For patients with more than 1 year of follow-up, urinary continence recovery with ≤1 pad was achieved in two cases within 1 year, whereas four cases did not recover urinary continence within 1 year. This case series demonstrated the feasibility of salvage RARP after carbon ion radiotherapy. Although the urinary continence recovery was modest, short-term disease control was favorable.

Long-term Outcomes and Patient Satisfaction Following Salvage Robot-assisted Radical Prostatectomy: A Modern Perspective

Background and objectiveApproximately two-thirds of men who undergo primary treatment for prostate cancer (PC) will experience biochemical recurrence (BCR). Salvage robot-assisted radical prostatectomy (sRARP) offers curative treatment in this disease setting and men who choose this option may avoid palliative androgen deprivation therapy (ADT). The purpose of this study was to describe long-term outcomes and patient feedback following sRARP. MethodsWe reviewed data for consecutive men with biopsy-proven localized BCR who underwent sRARP and pelvic lymph node dissection at a single tertiary referral center between 2004 and 2021. Perioperative data, Clavien-Dindo complications, and functional outcomes were recorded. The Kaplan-Meier method was used to estimate prostate-specific antigen–free (≥0.2 ng/ml) survival (PSAFS) and metastasis-free survival (MFS). Three Likert-type items (score 1-5) from the validated Surgical Satisfaction Questionnaire-8 were distributed to patients postoperatively. Key findings and limitationsWe included 78 men, of whom 72 (92%) had undergone primary radiotherapy and six (8%) had received primary prostate ablation. Median follow-up was 10.1 yr (interquartile range 5.8–12.4). Final pathology identified ≥pT3N0M0 in 35 patients (45%) and positive margins in 23 (29%). The overall complication rate was 50%. Of the 26 (33%) major (grade ≥III) complications, anastomotic stricture (32%) was most common. The estimated 3-, 5-, and 10-yr survival rates were 85.6% and 80.2%, 83.5% for PSAFS (n = 11), and 74.1%, 83.5%, and 70.5% for MFS (n = 23), respectively. At last follow-up, postoperative ADT had been administered to 17 patients (22%), and 39 men (50%) remained alive a decade after sRARP. Continence and potency were maintained in 33/62 (53%) and 1/16 (6%) patients, respectively. Thirty-five respondents (45%) reported median questionnaire scores (≥4) in favor of sRARP. Limitations include the small single-center series and a single query point for patient feedback. Conclusions and clinical implicationsLong-term outcomes of sRARP suggest that the technical challenges and morbidity of the procedure are qualified by patient feedback and the opportunity to evade the morbidity and mortality of biochemically recurrent PC. Patient summaryWe reviewed the cancer outcomes and side effects of robot-assisted surgical removal of the prostate after treatment failure with radiation or ablation for prostate cancer. We found that this type of treatment has substantial risks and long-term side effects, but the surgery provides an opportunity to cure prostate cancer and/or avoid the consequences of indefinite hormonal treatment. Overall, most men who underwent this surgery were not disappointed with their decision despite the higher risks and consequences.

Outcomes of salvage robot-assisted radical prostatectomy in patients who had primary focal versus whole-gland ablation: a multicentric study.

In the present study, we present comparative outcomes of radical prostatectomy after whole-gland therapy (wg-SRARP) and focal gland therapy (f-SRARP). The study assessed 339 patients who underwent salvage robot-assisted radical prostatectomy (SRARP); 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. Cox proportional hazard was used to study the functional and oncological outcomes. The median total operative time for f-SRARP was 18min higher than wg-RARP (p < 0.001). Higher rates of nerve-sparing were performed in f-SRARP (focal vs whole gland; bilateral-15.2% vs 9.3%; unilateral 49% vs 28.4%; p < 0.001). wg-SRARP had higher rates of ISUP 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 f-SRARP had higher rates of ISUP 4 (11.7% vs 10.7%; p < 0.001) and ≥ pT3a (64.8% vs 51.6%; p < 0.001). Positive margins were significantly higher with f-SRARP (26.2% vs 10.3%; p < 0.001). Functional outcomes were poor in both the groups. However, postoperative continence was higher and faster in patients who had f-SRARP compared to wg-SRARP (69% vs. 54.6%; p = 0.013). We could not identify statistically significant difference in postoperative potency recovery and biochemical recurrence. We present the largest multi-institutional analyses of f-SRARP and wg-SRARP. SRARP is challenging wherein patients have adverse pathological features and increased surgical complexity irrespective of the primary treatment. Focal therapy group had higher rates of nerve-sparing, however, with increased positive surgical margins. Both groups had poor functional outcomes regardless of nerve-sparing degree, indicating significant ipsilateral and contralateral damage to tissues surrounding the prostate during primary treatment. We believe that this analysis is crucial for counseling patients regarding expected outcomes before performing a salvage treatment following ablative therapy failure.

MP56-13 PERIOPERATIVE AND SURVIVAL OUTCOMES OF PATIENTS WITH A HISTORY OF PELVIC RADIATION UNDERGOING SALVAGE ROBOT-ASSISTED RADICAL CYSTECTOMY. AN RRC-ICUD COLLABORATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP56-13 PERIOPERATIVE AND SURVIVAL OUTCOMES OF PATIENTS WITH A HISTORY OF PELVIC RADIATION UNDERGOING SALVAGE ROBOT-ASSISTED RADICAL CYSTECTOMY. AN RRC-ICUD COLLABORATIVE STUDY Giovanni Cacciamani, Joge Ballon, Viktor Skokic, Gus Miranda, John Sfakianos, Etienne Lavallee, Yuan Shuo Wang, Linda Dey, Arad Hosseini, Juhana Rautiola, Gunnar Steineck, Monish Aron, Inderbir Gill, Abolfazl Hosseini, Reza Mehrazin, Peter Wiklund, and Mihir Desai Giovanni CacciamaniGiovanni Cacciamani More articles by this author , Joge BallonJoge Ballon More articles by this author , Viktor SkokicViktor Skokic More articles by this author , Gus MirandaGus Miranda More articles by this author , John SfakianosJohn Sfakianos More articles by this author , Etienne LavalleeEtienne Lavallee More articles by this author , Yuan Shuo WangYuan Shuo Wang More articles by this author , Linda DeyLinda Dey More articles by this author , Arad HosseiniArad Hosseini More articles by this author , Juhana RautiolaJuhana Rautiola More articles by this author , Gunnar SteineckGunnar Steineck More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Reza MehrazinReza Mehrazin More articles by this author , Peter WiklundPeter Wiklund More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are lack of data on salvage robot-assisted radical cystectomy (sRRC) after pelvic radiation therapy (RT) in patients with bladder cancer. We present perioperative, oncological, and long terms survival outcomes for patients with a history of pelvic radiation who had undergone sRRC from 3 high-volume centers. METHODS: Data from prospectively maintained databases from 3 centers (USC, Karolinska Institute, Mount Sinai) from 2009-2019 were retrospectively reviewed. Patients with a history of pelvic radiation who underwent sRRC with Intracorporeal (ICUD) or extracorporeal (ECUD) for intent to cure bladder cancer were identified. Using a propensity score estimation (based on age, BMI, gender, ASA score, neoadjuvant chemotherapy, and clinical tumor stage (Caliper size 0.2), patients were matched 1:1 to a cohort undergoing RRC without prior history of pelvic radiation. Both groups were compared for perioperative, oncologic, and survival outcomes with up to 3 years of follow-up. RESULTS: A total of 92 sRRC were PS matched to 92 patients undergoing RRC. While both groups were similar in the proportion of ICUD (70.3 vs 78.3%, p=0.29), the sRRC had a lower proportion of continent diversion (6.7 vs 22.8%, p=0.004)). There were no significant differences between the 2 groups in operative time (333.8 vs 348.2 minutes, p=0.246), postoperative complications, at 30 days (p=0.36), and 31-90 days (p=0.64), and readmission rates at 30 days (16.3 vs 19.6%, p=0.70) and 31-90 days (16.5 vs 21.8%, p=0.48). The sRRC group had a lower number of lymph nodes (LNDs) retrieved (20.1 vs 29, p≤0.001), positive LNDs (0.3 vs 1.7, p=0.007), and positive LNDs rate (0.03 vs 0.07%, p=0.035). However no significant differences observed in tumor stage (p=0.41) and LNDs stage (p=0.065) and rate (23.9 vs 29.3; p=0.5). At 3 years, OSS (59.1 vs 67.8% p=0.27), CSS (74.9 vs 74.4% p=0.59), and RFS (70.7 vs 76.1 p=0.67) were similar between sRRC and RRC. CONCLUSIONS: This largest multi-institutional contemporary study provides the best evidence to date supporting the feasibility of sRRC. Perioperative and survival outcomes were comparable between the two groups indicating that sRRC is feasible for selected patients who have underwent pelvic RT. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e779 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cacciamani More articles by this author Joge Ballon More articles by this author Viktor Skokic More articles by this author Gus Miranda More articles by this author John Sfakianos More articles by this author Etienne Lavallee More articles by this author Yuan Shuo Wang More articles by this author Linda Dey More articles by this author Arad Hosseini More articles by this author Juhana Rautiola More articles by this author Gunnar Steineck More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Abolfazl Hosseini More articles by this author Reza Mehrazin More articles by this author Peter Wiklund More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...

Perioperative and survival outcomes of patients with a history of pelvic radiation undergoing salvage robot-assisted radical cystectomy. An rrc-icud collaborative study

Perioperative and survival outcomes of patients with a history of pelvic radiation undergoing salvage robot-assisted radical cystectomy. An rrc-icud collaborative study

Salvage Robot-Assisted Radical Prostatectomy (sRARP) for Radiation-Recurrent Prostate Cancer: a Single-Center Experience.

This case series reported on five patients with radiation-recurrent localized prostate cancer (PCa) who underwent salvage robot-assisted radical prostatectomy (sRARP). Median postoperative follow-up period was 8months. Median (range) peri-operative parameters such as operative time, the estimated blood loss, and length of hospital stay were 127min (113-158), 61ml (54-111), and 9days (8-11), respectively. None of the five patients required conversion to an open approach or required a blood transfusion, or experienced a rectal/ureteral injury. Urinary leakage was present in one patient (20%) at the initial cystogram. Transurethral electrocoagulation under spinal anesthesia was required to control hematuria in one patient (20%). Two patients (40%) experienced biochemical progression; no patient died from PCa or other causes during the follow-up period. Of five patients, three (60%) were continent. For patients with radiation-recurrent localized PCa, sRARP might become a feasible surgical option with acceptable outcomes.

PE14 - Salvage robot-assisted radical prostatectomy in patient underwent primary HIFU: A tertiary care center experience

PE14 - Salvage robot-assisted radical prostatectomy in patient underwent primary HIFU: A tertiary care center experience

PD54-07 COMPARATIVE EFFECTIVENESS ANALYSES OF SALVAGE PROSTATECTOMY AND SALVAGE RADIOTHERAPY OUTCOMES FOLLOWING FOCAL OR WHOLE-GLAND ABLATIVE THERAPY (HIGH INTENSITY FOCUSED ULTRASOUND (HIFU), CRYOTHERAPY OR ELECTROPORATION) FOR LOCALISED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD54-07 COMPARATIVE EFFECTIVENESS ANALYSES OF SALVAGE PROSTATECTOMY AND SALVAGE RADIOTHERAPY OUTCOMES FOLLOWING FOCAL OR WHOLE-GLAND ABLATIVE THERAPY (HIGH INTENSITY FOCUSED ULTRASOUND (HIFU), CRYOTHERAPY OR ELECTROPORATION) FOR LOCALISED PROSTATE CANCER Alexander Ng, Arjun Nathan, Anita Mitra, Prasanna Sooriakumaran, Reena Davda, Sonam Patel, Monty Fricker, John Kelly, Greg Shaw, Prabhakar Rajan, Ashwin Sridhar, Senthil Nathan, and Heather Payne Alexander NgAlexander Ng More articles by this author , Arjun NathanArjun Nathan More articles by this author , Anita MitraAnita Mitra More articles by this author , Prasanna SooriakumaranPrasanna Sooriakumaran More articles by this author , Reena DavdaReena Davda More articles by this author , Sonam PatelSonam Patel More articles by this author , Monty FrickerMonty Fricker More articles by this author , John KellyJohn Kelly More articles by this author , Greg ShawGreg Shaw More articles by this author , Prabhakar RajanPrabhakar Rajan More articles by this author , Ashwin SridharAshwin Sridhar More articles by this author , Senthil NathanSenthil Nathan More articles by this author , and Heather PayneHeather Payne More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002631.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ablative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatments. We compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). METHODS: Data were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases, after ablative therapy failure, in a high-volume tertiary centre. RESULTS: High-risk patients were over-represented in the SRARP group (66.0%) compared to the SRT group (48.0%) (p=0.013). Median (IQR) follow-up after SRARP was 16.5 (10.0-30.0) months and 37.0 (18.5-64.0) months after SRT. SRT appeared to confer greater biochemical recurrence (BCR)-free survival at one, two and three years compared to SRARP in high-risk patients (year 3: 86.3% vs 66.0%), but BCR-free survival was similar for intermediate-risk patients (year 3: 90.0% vs 75.6%). There was no statistical difference in pad-free continence at 12- and 24-months between SRARP (77.2% and 84.7%) and SRT (75.0% and 74.0%) (p=0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0% and 45.0%, grade II were 11.0% and 11.0%, and grade III or IV complications were 4.0% and 5.0%, respectively. CONCLUSIONS: We report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e918 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Ng More articles by this author Arjun Nathan More articles by this author Anita Mitra More articles by this author Prasanna Sooriakumaran More articles by this author Reena Davda More articles by this author Sonam Patel More articles by this author Monty Fricker More articles by this author John Kelly More articles by this author Greg Shaw More articles by this author Prabhakar Rajan More articles by this author Ashwin Sridhar More articles by this author Senthil Nathan More articles by this author Heather Payne More articles by this author Expand All Advertisement PDF DownloadLoading ...

Salvage robot-assisted radical prostatectomy following focal ablation with irreversible electroporation: feasibility, oncological and functional outcomes

BackgroundTo report the feasibility, oncological and functional outcomes of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer (PCa) after irreversible electroporation (IRE).MethodsThis was a retrospective analysis of patients who underwent sRARP by a single high-volume surgeon after IRE treatment in our institution. Surgical complications, oncological and functional outcomes were assessed.Results15 patients with at least 12 months follow up were identified out of the 234 men who underwent primary IRE between 2013 and 2019. The median [IQR] age was 68 (62–70) years. The median [IQR] time from focal IRE to sRARP was 42 (21–57) months. There were no rectal, bladder or ureteric injuries. The T-stage was pT2 in 9 (60%) patients and pT3a in 6 (40%) patients. Only one (7%) patient had a positive surgical margin. At a median [IQR] follow up of 22 (16–32) months no patient had a biochemical recurrence (PSA > 0.2). All 15 patients were continent (pad-free) by 6 months and 9 (60%) patients had erections sufficient for intercourse with or without PDE5 inhibitors. No predisposing factors were identified for predicting erectile dysfunction after sRARP.ConclusionsIn patients with recurrent or residual significant PCa after focal IRE ablation it is feasible to obtain good functional and oncological outcomes with sRARP. Our results demonstrate that good outcomes can be achieved with sRARP, when respecting close monitoring post-IRE, good patient selection and surgical experience. The limitations of this study are that it is a small series, with short follow up and a lack of standardised quality of life instruments.

A0967 - Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); a matched analysis

A0967 - Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); a matched analysis

A0968 - Peri- and postoperative outcomes of salvage robot-assisted radical prostatectomy in prostate cancer patients: A high-volume center experience

A0968 - Peri- and postoperative outcomes of salvage robot-assisted radical prostatectomy in prostate cancer patients: A high-volume center experience

Robotic radical prostatectomy in post HIFU salvage setting: tertiary center experience and review of the current literature

Aim: The purpose of the study was to describe our surgical technique of salvage robot-assisted radical prostatectomy (sRARP) in patients who underwent primary high-intensity focused ultrasound (HIFU) and to report the perioperative, functional, and oncological outcomes during the first year follow up. The secondary aim of the study was to review the current literature evidence on this topic. Methods: We retrospectively extracted, from our prospective RARP database, all the patients who underwent sRARP for biochemical recurrence after primary HIFU. All the surgical interventions were performed by a single surgeon following our total anatomical reconstruction (TAR) technique. Demographics, perioperative, functional, and oncological results were collected up to one year follow-up. Results: Eleven patients underwent post-HIFU sRARP with TAR technique at our institution. All the surgical procedures were uneventful. All the complication recorded were classified as Clavien-Dindo Grade I. Continence rate at 1-, 3-, 6-, and 12-month post intervention was 36.3%, 45.5%, 63.6 %, and 81.1%, respectively. Medium PSA at 12 months follow-up was 0.2 ng/mL (SD 0.01), with no Biochemical Failure (BCF) recorded. Conclusion: sRARP with TAR technique is a safe and feasible procedure in patients with BCF after primary HIFU. No major complications were recorded, with good oncological and functional results after one year follow up.

What happens if focal therapy fails? A comparative effectiveness study of salvage treatment for recurrent prostate cancer

Introduction: Focal therapy is an emerging treatment for localised prostate cancer. However, a third of patients require further salvage treatment after failure. Limited descriptive, but no comparative, evidence exists for different salvage treatments. We compare outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT).

Comparative Effectiveness Analyses of Salvage Prostatectomy and Salvage Radiotherapy Outcomes Following Focal or Whole-Gland Ablative Therapy (High-Intensity Focused Ultrasound, Cryotherapy or Electroporation) for Localised Prostate Cancer

AimsAblative therapy, such as focal therapy, cryotherapy or electroporation, aims to treat clinically significant prostate cancer with reduced treatment-related toxicity. Up to a third of patients may require further local salvage treatment after ablative therapy failure. Limited descriptive, but no comparative, evidence exists between different salvage treatment outcomes. The aim of this study was to compare oncological and functional outcomes after salvage robot-assisted radical prostatectomy (SRARP) and salvage radiotherapy (SRT). Materials and methodsData were collected prospectively and retrospectively on 100 consecutive SRARP cases and 100 consecutive SRT cases after ablative therapy failure in a high-volume tertiary centre. ResultsHigh-risk patients were over-represented in the SRARP group (66.0%) compared with the SRT group (48.0%) (P = 0.013). The median (interquartile range) follow-up after SRARP was 16.5 (10.0–30.0) months and 37.0 (18.5–64.0) months after SRT. SRT appeared to confer greater biochemical recurrence-free survival at 1, 2 and 3 years compared with SRARP in high-risk patients (year 3: 86.3% versus 66.0%), but biochemical recurrence-free survival was similar for intermediate-risk patients (year 3: 90.0% versus 75.6%). There was no statistical difference in pad-free continence at 12 and 24 months between SRARP (77.2 and 84.7%) and SRT (75.0 and 74.0%) (P = 0.724, 0.114). Erectile function was more likely to be preserved in men who underwent SRT. After SRT, cumulative bowel and urinary Radiation Therapy Oncology Group toxicity grade I were 25.0 and 45.0%, grade II were 11.0 and 11.0% and grade III or IV complications were 4.0 and 5.0%, respectively. ConclusionWe report the first comparative analyses of salvage prostatectomy and radiotherapy following ablative therapy. Men with high-risk disease appear to have superior oncological outcomes after SRT; however, treatment allocation does not appear to influence oncological outcomes for men with intermediate-risk disease. Treatment allocation was associated with a different spectrum of toxicity profile. Our data may inform shared decision-making when considering salvage treatment following focal or whole-gland ablative therapy.

PE06 - Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis

PE06 - Outcomes of Salvage Robot-Assisted Radical Prostatectomy (S-RARP) post focal ablation for prostate cancer in comparison with primary Robot-assisted Radical Prostatectomy (RARP); A matched analysis

Comment on: "The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study".

article: Comment on: “The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study” - Minerva Urology and Nephrology 2021 October;73(5):680-2 - Minerva Medica - Journals

The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study.

The aim of this study was to report the overall results and the learning curve (LC) in salvage robot-assisted radical prostatectomy (sRARP) patients, in terms of morbidity, oncological and functional outcomes in a single surgeon tertiary-referral center. One hundred and twenty patients underwent sRARP by a single surgeon (V.P.) from 2008 to 2018. To assess the trends in the learning experience they were sub-divided in 4 groups of 30 consecutive patients based on date of surgery. The Kaplan-Meier method and regression models were used to identify survival estimations and predictors of potency, continence and biochemical failure (BCF) at 12 months. As the learning experience for sRALP increased operative time (OT) was significantly shorter (from 139.5 to 121 minutes) and the amount of nerve-sparing (NS) undertaken increased (from 46% to 80%). While complications rate remained stable, estimated blood loss (EBL) and radiographic anastomotic leaks (RAL) decreased through the groups (from 124 to 69 ml and 40% to 16,7%, respectively). BCF and continence rates at 12 months after sRARP were similar among groups (23-36% and 36,7-50%, respectively) and chance of potency rates tended to increase (from 3.3% to 16-23%) but was not statistically significant. In a multivariate analysis, predictors for BCF were PSM and GS 8-10. Non-radiation primary treatment was the unique predictor of continence at 12 months after sRARP. Our data may suggest a decreasing trend in terms of OT and EBL through the sRARP learning curve. While morbidity remained stable through the time, RAL trended towards a decline. A higher degree of NS was observed through the groups and there was a slight correlation trend between surgical expertise and potency recovery. PSM and GS 8-10 were predictors of BCF and non-radiation primary treatment predicted a better continence after sRARP.

Outcomes of Salvage Robot-assisted Radical Prostatectomy After Focal Ablation for Prostate Cancer in Comparison to Primary Robot-assisted Radical Prostatectomy: A Matched Analysis

BackgroundFocal therapy (FT) for prostate cancer is less invasive than radical treatment but carries a risk of recurrence. Salvage robot-assisted radical prostatectomy (S-RARP) is a possible option after FT failure. ObjectiveTo evaluate the impact of FT on functional and oncological outcomes following S-RARP. Design, setting, and participantsIn a retrospective analysis of data from a prospectively collected institutional database, 53 patients who underwent S-RARP following failure of focal ablation were selected as group I; patients who had whole-gland ablation and external beam therapy were excluded. This group was matched to a control sample (matched at ratios of 1:1, 1:2, 1:3, 1:4) of men who had undergone primary RARP, using age, prostate-specific antigen (PSA), PSA density, body mass index, Sexual Health Inventory for Men score, American Urological Association symptom score, Charlson comorbidity index, prostate weight, preoperative Gleason score (GS), and history of smoking as variables. Surgical procedureS-RARP after FT was performed using a standardized technique developed at our institute with the da Vinci Xi Surgical System. MeasurementsOncological and functional outcomes were compared between the S-RARP and primary RARP groups. Results and limitationsThere was no difference in estimated blood loss (p = 0.8) between the 1:1 matched groups, but operating room time was significantly longer for S-RARP (p = 0.007). The primary RARP group had a higher proportion of patients who underwent a full nerve-sparing procedure. The S-RARP group had higher incidence of positive surgical margins (40% vs 15%; p = 0.008), GS ≥8 (25% vs 15%; p = 0.07), and positive lymph node status (9.4% vs 5.7%; p = 0.02). There was no significant difference in overall complications between the groups. The primary RARP group had a higher incidence of lymphocele drainage after surgery (15% vs 0%; p = 0.006). The main limitation of the study is its retrospective design. ConclusionsS-RALP after FT failure is feasible; however, surgery following FT leads to poorer oncological and functional outcomes. Despite the targeted nature of FT, significant nonfocal collateral damage is evident in tissues surrounding the prostate, which in turn translates to poorer functional outcomes after S-RARP. Patient summaryWe studied the surgical challenges during robot-assisted removal of the prostate after previous focal treatment (FT) for prostate cancer and compared the outcomes to those for robot-assisted prostate removal in patients who had no previous FT. We found that this technique is safe and effective with a limited risk of complications, but poor urinary and sexual functional outcomes.

Early Experience with Salvage Robotic-Assisted Radical Prostatectomy in Proton Beam Radiotherapy Failures.

Aims: To assess the perioperative and short-term functional and oncologic outcomes of the salvage robot-assisted radical prostatectomy (sRARP), after recurrence following primary proton beam therapy for clinically localized prostate cancer.Methods: Ten patients undergoing sRARP after failure of the prior definitive proton beam therapy for localized prostate cancer were included. BCR is defined as a prostate-specific antigen (PSA) value of 2.0 ng/mL greater than the absolute nadir. All of the individuals had a diagnosis of prostate cancer via biopsy after proton beam therapy, with negative findings on magnetic resonance imaging/computer tomography of the pelvis and abdomen, and a bone scan. The sRARP procedure with pelvic lymph node dissection was performed by a single surgeon in all patients.Results: The median age of the cohort at sRARP was 66.8 years, and the mean BMI was 29.2 kg/m2. The mean duration from proton beam therapy to sRARP was 58.4 months; the mean preoperative PSA level was 5.5 ng/mL, the mean operative time was 230 minutes, and the approximate blood loss was 745 mL. Anastomotic leakage occurred in half of the individuals, and bladder neck contracture developed in 6 patients. For 8 patients, the continence results within 6 months follow-up were available. Overall, 24 complications occurred in 9 patients. At follow-up in the 32nd month, the overall survival rate was 80%, and the BCR-free survival rate was 90%.Conclusion: sRARP after proton beam therapy is an applicable procedure, but has a high risk of serious complications.