Outcomes of Salvage Robotic-assisted Radical Prostatectomy: High-volume Multicentric Data from the European Association of Urology Robotic Urology Section Scientific Working Group

Abstract

Background and objective: Salvage robotic-assisted radical prostatectomy (S-RARP) is one option for treating patients with recurrent prostate cancer after prostate-preserving primary therapy. However, the tissue damage, anatomical distortion, and lack of surgical landmarks caused by the primary treatment still constitute a major challenge to surgeons. We aim to report the experience of our group on S-RARP.

Methods and surgical procedure: A retrospective multicentric study including data from nine centers from the European Association of Urology Robotic Urology Section Scientific Working Group was conducted. Overall, 397 patients who underwent S-RARP from 2008 to 2023 were included and divided into three groups (primary radiation therapy [RT], whole gland [WG] ablation, and focal gland [FG] ablation). The primary endpoints were the safety and feasibility of S-RARP. The secondary endpoints were the comparison of functional and oncological outcomes among different primary therapies.

Key findings and limitations: The median (interquartile range) follow-up periods for RT, FG ablation, and WG ablation were 38 (19-73), 20 (10-37), and 24 (16-38) mo, respectively (p < 0.001). Only four patients (1%) had intraoperative complications and <2% had Clavien grade ≥3 after surgery. The 5-yr cumulative incidence rates of biochemical recurrence were 35%, 45%, and 23% for RT, FG ablation, and WG ablation, respectively (p = 0.3). The 3-yr cumulative incidence rates of continence were 67%, 92%, and 71% for RT, FG ablation, and WG ablation, respectively (p < 0.001). The 5-yr cumulative incidence rates of potency were 16%, 11%, and 5.3% (p = 0.2), while the overall survival rates at 5 yr were 95%, 94%, and 100% for RT, FG ablation, and WG ablation, respectively (p = 0.7).

Conclusions: S-RARP is safe and feasible with very low rates of perioperative complications. Functional outcomes in patients undergoing S-RARP are inferior to outcomes at primary surgery and demand highly skilled surgical expertise. Patients should be counseled carefully that the functional outcomes are inferior to those at primary surgery.

Keywords: Prostate cancer; Prostate cancer recurrence; Salvage robotic-assisted radical prostatectomy.