PURPOSE: Salvage robotic-assisted laparoscopic prostatectomy (sRALP) is a treatment option for certain patients with recurrent prostate cancer (CaP) after primary therapy.
Data regarding patient selection, complication rates, and cancer outcomes are scarce. Here, we report the largest, single-institution series to date of sRALP.
METHODS: We reviewed our database of 4,234 patients who have undergone robotic-assisted laparoscopic prostatectomy at Vanderbilt University and identified 34 men who had surgery after failure of prior definitive ablative therapy. Each patient had biopsy-proven recurrent CaP and no evidence of metastases. The primary outcome measure was biochemical failure (BCF).
RESULTS: The median time from primary therapy to sRALP was 48.5 months with a median PSA prior to sRALP of 3.86 ng/mL. Most patients had Gleason scores ≤ 7 on pre-sRALP biopsy, although 12 patients (35%) had ≥ Gleason 8 disease. After a median follow-up of 16 months, 18% had BCF. The positive margin rate was 26%, of which 33% had BCF following surgery. On univariable analysis, there was a significant association between PSA doubling time and BCF (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.60-0.99; p=0.049) as well as between Gleason score at original diagnosis and BCF (HR 3.49, 95% CI 1.18-10.3; p=0.023). There were two Clavien II-III complications: a pulmonary embolism and a rectal laceration. Post-operatively, 39% had excellent continence.
CONCLUSIONS: sRALP is safe, with many outcomes favorable to open, salvage radical prostatectomy series. Advantages include superior visualization of the posterior prostatic plane, modest blood loss, low complication rates, and short length of stay.
Written by:
Kaffenberger SD, Keegan KA, Bansal NK, Morgan TM, Tang DH, Barocas DA, Penson DF, Davis R, Clark PE, Chang SS, Cookson MS, Herrell SD, Smith JA Jr. Are you the author?
Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN.
Reference: J Urol. 2012 Sep 20. pii: S0022-5347(12)04913-0.
doi: 10.1016/j.juro.2012.09.057
PubMed Abstract
PMID: 23000849
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