Robot-assisted Radical Prostatectomy After Focal Therapy: Oncological, Functional Outcomes and Predictors of Recurrence.

There are few data on the outcomes and toxicity of radical prostatectomy (RP) among men experiencing local recurrence of prostate cancer (PC) following focal therapy (FT). To characterise perioperative, oncological, and functional outcomes after salvage robot-assisted RP (S-RALP) and determine the risk factors for S-RALP failure, we conducted a multicentre cohort study of 82 patients undergoing S-RALP after FT. All had histological confirmation of PC recurrence, with metastatic disease excluded using pelvic magnetic resonance imaging, a bone scan, and/or positron emission tomography/computed tomography. Progression-free survival was 74%, 48%, and 36% at 12, 24, and 36mo after surgery, respectively. The 12-mo continence rate was 83%. There were no intraoperative complications and no major postoperative complications. On multivariable analysis, only infield recurrence (hazard ratio [HR] 3.77, 95% confidence interval [CI] 1.11-12.85; p=0.03) and pT3b stage (HR 5.0, 95% CI 1.53-16.39; p=0.008) were independent predictors of recurrence. This study represents the largest series of salvage surgery after FT and shows that this approach is safe with no increase in toxicity when compared to primary RALP. Men identified as having infield recurrence after FT appear to have phenotypically aggressive disease and should be counselled regarding the potential need for a multimodal therapeutic approach. PATIENT SUMMARY: Robotic surgery after focal therapy for prostate cancer is safe and achieves postoperative continence results similar to those for robotic radical prostatectomy in treatment-naïve patients. However, if the cancer recurrence is within the previously treated field, the oncological prognosis seems to be worse.

European urology. 2019 Mar 21 [Epub]

Lorenzo Marconi, Thomas Stonier, Rafael Tourinho-Barbosa, Caroline Moore, Hashim U Ahmed, Xavier Cathelineau, Mark Emberton, Rafael Sanchez-Salas, Paul Cathcart

Urology Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK. Electronic address: ., Department of Urology, Kings College Hospital, London, UK., Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France., Department of Urology, University College London Hospitals, London, UK., Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK., Department of Urology, University College London Hospitals, London, UK; Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK., Urology Centre, Guy's and St. Thomas NHS Foundation Trust, London, UK. Electronic address: .

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