Salvage Outcomes Favorable With Robotic-Assisted Laparoscopic Prostatectomy

When prostate cancer recurs after primary therapy, robotic-assisted laparoscopic prostatectomy "is an attractive alternative" to open radical prostatectomy and could possibly have superior outcomes.
That's according to a report in the Journal of Urology online September 20 from Dr. Joseph A. Smith and colleagues at Vanderbilt University Medical Center in Nashville, Tennessee.

"Although salvage surgery for locally-recurrent prostate cancer is challenging, a high proportion of patients after sRALP (salvage robotic-assisted laparoscopic prostatectomy) have encouraging early oncologic results," the researchers write.

Open salvage radical prostatectomy after localized relapse can yield five-year recurrence-free survival rates of 85%, the authors say - but the procedure is technically challenging and the morbidity rate "daunting."

Outcomes with robotic-assisted laparoscopic prostatectomy in the salvage setting haven't been widely reported. In the present study, the authors reviewed the outcomes of 34 men who had the procedure after experiencing local, non-metastatic recurrence of prostate cancer following prior definitive ablative therapy - i.e., external beam radiation, brachytherapy, or a combination of both, or high intensity ultrasound.

The median operative time was 176 minutes, according to the report, and 29 of the men (85%) also underwent bilateral pelvic lymphadenectomy. There were two major complications: a pulmonary embolism, and a rectal laceration requiring repair. Postop, 12 patients had "excellent" urinary continence, the investigators report.

Surgical margins were positive in nine patients (26%), although this was not significantly associated with biochemical failure. Six patients (18%) had biochemical failure during a median follow-up of 16 months.

Factors associated with biochemical failure were the Gleason score at original diagnosis of prostate cancer, and the PSA doubling time (PSADT).

"When viewed in conjunction with patient factors such as life expectancy and pre-sRALP PSA, our results suggest that those with slow PSADT and low-grade disease at original diagnosis are most likely to benefit from sRALP," Dr. Smith and colleagues suggest.

They also point out the low rates of bladder neck contractures, short length of stay, and modest blood loss with salvage robotic-assisted laparoscopic radical prostatectomy compared with the open procedure, which led them to conclude, "Our data suggest that sRALP is a safe and compelling alternative to open SRP and may offer some advantages."