Salvage radiotherapy after robot-assisted laparoscopic radical prostatectomy

Area of Science:

• Urology
• Oncology
• Radiation Oncology

Background:

• Robot-assisted radical prostatectomy (RARP) is increasingly used for prostate cancer treatment.
• Adjuvant therapies, including salvage radiotherapy (SRT), are frequently employed post-RARP.
• The potential for improved SRT response after RARP due to altered recurrence patterns warrants investigation.

Purpose of the Study:

• To determine the incidence and effectiveness of SRT in patients who have undergone RARP.
• To compare the outcomes of SRT in a RARP cohort with predictions from the Stephenson nomogram.
• To evaluate factors influencing treatment response in men receiving SRT after RARP.

Main Methods:

• Prospective registration of patient data.
• Definition of biochemical recurrence (BCR) as prostate-specific antigen (PSA) ≥0.1 ng/mL.
• Application of the Stephenson nomogram for outcome prediction and comparison with actual SRT results.

Main Results:

• 14.4% of 1087 men received SRT for BCR or persistent PSA post-RARP.
• The 3-year BCR-free rate after SRT was 64%.
• Pre-SRT PSA levels and pN stage were independent predictors of BCR-free interval; fascia preservation correlated with favorable response. The Stephenson nomogram showed 0.66 concordance.

Conclusions:

• SRT use and efficacy in RARP patients are comparable to those in open prostatectomy series.
• The Stephenson nomogram reliably predicts outcomes for RARP patients undergoing SRT.
• Predictive factors for SRT response appear consistent between RARP and open prostatectomy cohorts.