Robot-assisted salvage prostatectomy: evaluation of initial patient-reported outcomes

For patients who experience a localized recurrence after definitive radiation therapy for prostate cancer, salvage prostatectomy provides a chance for cure. We sought to assess whether robot assistance would decrease the technical challenges and mitigate the considerable morbidity associated with the procedure.

Using institutional data, we identified six patients who underwent robot-assisted prostatectomy after definitive radiation therapy. For all patients, preoperative and postoperative quality of life were measured using the Sexual Health Inventory for Men and the Expanded Prostate Cancer Index Composite (EPIC). Further, intraoperative and postoperative complications were assessed.

Functional status of patients before robot-assisted salvage prostatectomy is compromised. Three of the six patients had extremely poor sexual function before surgery (EPIC sexual domain <50), and three-quarters had significant irritative symptoms (mean EPIC urinary irritation score 60.5). Surgery was performed safely with no intraoperative complications. Postoperative complications developed in three patients, all of whom were managed conservatively. Of the six patients, four (75%) remain free of disease; however, incontinence and erectile dysfunction were evident in all, to some degree.

Salvage robot-assisted radical prostatectomy is a safe and effective modality for salvaging patients with localized prostate cancer after radiation. Morbidity remains high, however, likely secondary to the consequences of radiation.