Presentation Authors: Fikret Onol*, Seetharam Bhat, Travis Rogers, Hariharan Ganapathi, Cathy Jenson, Vipul Patel, Orlando, FL
Introduction: Outcomes of salvage robotic-assisted prostatectomy (sRALP) in post-primary radiation (RAD) vs. ablation (ABL) therapies were not thoroughly investigated. We compared the clinical and oncological outcomes in these patients by examining the largest single-surgeon sRALP series reported to date.
Methods: We retrospectively reviewed our IRB-approved database including >11.500 RALP cases. Between July 2008 and April 2018, 121 patients underwent sRALP by a single surgeon (VP). Of these, 90 (74.3%) and 31 (25.7%) patients had underwent RAD and ABL, respectively; including external beam radiation (EBRT, n=37), intensity modulated radiation (n=14), proton beam radiation (n=3), brachytherapy (n=22), combined EBRT and brachytherapy (n=14), HIFU (n=9), cryoablation (n=18), and other (electroporation, microwave, n=4) therapies. We analyzed the differences in clinical and oncological outcomes between RAD and ABL groups by using t-test, chi-square and Fisher&[prime]s exact tests.
Results: Preoperative characteristics were similar between 2 groups, except for sexual function (Table 1). Before surgery, 38% of patients in ABL group were potent as compared to 18% in RAD group (p=0.06). Operative times, perioperative complication rates, postoperative catheter duration and cystographic leak rates were not significantly different between 2 groups (Table 1). At final pathology, ABL group showed higher non-organ confined disease rates (71% vs 47.8%, p=0.036) and higher positive surgical margin (PSM) rates as compared to RAD group (45% vs. 17%, p=0.004). Based on functional outcomes follow-up data (n=105), 9.7% of men in RAD and 26% of men in ABL group achieved potency (p=0.125) at a median 24.2 months follow-up (range: 3-116). Postoperative full continence (no pads/day) and social continence (0-1 pad/day) rates were significantly higher in ABL as compared to RAD group (73.9% vs. 46.3%, p=0.031 and 88.9% vs. 54.7%, p=0.012, respectively). Full continence rates at 3, 6, 9, and 12 months were significantly higher in ABL group (Table 1).
Conclusions: All salvage prostatectomies are not the same. When discussing sRALP, patients should be warned that RAD is associated with higher postoperative incontinence rates and ABL is associated with higher non-organ confined disease and PSM rates.