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

Area of Science:

• Urology
• Oncology
• Surgical Innovation

Background:

• Limited data exist on radical prostatectomy (RP) outcomes and toxicity following prostate cancer (PC) local recurrence after focal therapy (FT).
• Salvage robot-assisted RP (S-RALP) is a potential treatment option for these patients.

Purpose of the Study:

• To evaluate perioperative, oncological, and functional outcomes of S-RALP after FT.
• To identify risk factors for S-RALP failure in men with recurrent PC post-FT.

Main Methods:

• A multicentre cohort study included 82 patients undergoing S-RALP after FT for histologically confirmed PC recurrence.
• Metastatic disease was excluded using imaging (MRI, bone scan, PET/CT).
• Progression-free survival (PFS) and complication rates were assessed.

Main Results:

• Progression-free survival rates were 74% at 12 months, 48% at 24 months, and 36% at 36 months.
• The 12-month continence rate was 83% with no intraoperative or major postoperative complications.
• Infield recurrence and pT3b stage were independent predictors of recurrence on multivariable analysis.

Conclusions:

• S-RALP is a safe salvage treatment for PC recurrence post-FT, with toxicity comparable to primary RALP.
• Infield recurrence after FT indicates aggressive disease, potentially requiring multimodal therapeutic strategies.
• Patients with infield recurrence should be counseled on the poorer oncological prognosis and potential need for combined treatments.