SALVAGE ROBOTIC-ASSISTED RADICAL PROSTATECTOMY (SRALP) FOR TREATMENT OF RADIO-RECURRENT PROSTATE CANCER: DESCRIPTION OF TECHNIQUE AND MULTI-INSTITUTIONAL OUTCOMES

Introduction: Depending on initial prognostic factors, 10 to 60% of men who undergo definitive radiation therapy (RT) for localized prostate cancer (Pca) may experience biochemical recurrence (BCR). However, no consensus exists on the optimal salvage therapy for patients with local recurrence following RT. Herein we present our technique of sRALP and report a multiinstitutional experience with sRALP for treatment of recurrent prostate cancer after primary radiotherapy. Materials and Methods, Including a Description of the Video: We evaluated 15 patients who underwent sRALP for treatment of locally recurrent Pca at 4 different institutions between March 2007 and December 2008. Six patients had brachytherapy, four had external beam RT (EBRT), two had proton beam RT and three received brachytherapy with an EBRT boost. All patients had Pca on biopsy after RT, with negative CT and bone scan. The mean follow-up was 20.5 months. In this video, we present our technique of sRALP in a patient with BCR after definitive proton beam RT. Results: The mean time to BCR after RT was 32.39 months. The mean estimated blood loss was 76.67 ml and the mean operative time was 125.25 min. 3 patients (20%) presented BCR (PSA > 0.2), at 4 and 6 months; all 3 patients had negative surgical margins and underwent bilateral PLND which revealed no evidence of malignancy. There were no rectal injuries, blood transfusions, or conversion to open surgery; 3 pts developed postoperative DVT requiring anticoagulation. Eleven (73%) patients were continent (0 pads per day) with a minimum follow-up of three months after sRALP; no patients reported erections adequate for sexual intercourse. Conclusions: sRALP is a safe and feasible option for treatment of locally recurrent prostate cancer after definitive RT. Encouraging oncologic and functional outcomes with low perioperative morbidity were demonstrated in our multi-institutional series.