Salvage Robotic Prostatectomy after Brachytherapy

Fajardo-Paneque Marta, Congregado-Ruiz Belén, Conde-Sánchez Jose Manuel and Medina-López Rafael Antonio

Department of Urology, Virgen del Rocío Universitary Hospital, Spain

^*Correspondance to: Fajardo-Paneque Marta 

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Abstract:

Introduction: Salvage radical prostatectomy, although still underused, is becoming a feasible treatment for young, healthy patients with biochemical progression after initial treatment with radiotherapy. We introduce the first Spanish serie of salvage prostatectomies after low-dose rate brachytherapy and it constitutes the first comparative serie between open and robotic surgery at a single institution.Materials and
Methods: Descriptive and comparative study of fifteen patients who underwent salvage radical prostatectomy between December 2009 and May 2014. 8 patients underwent open surgery and 7 underwent robotics. We analyzed and compared clinical and oncologic parameters at diagnosis and at relapse (PSA, Gleason, clinical stage, time to progression), peri-operative complications, functional data and oncologic outcomes.Results: Median follow-up: 29.75 months in open prostatectomy and 11.29 in robotic one. The complication rate was higher in the open surgery group (50 vs. 28.5%). Four patients (26.7%) had postoperative persistent disease, three of them in the robotic group. In multivariable analysis we found no association between positive surgical margins (PSMs) and persistence of disease. None PSA recurrence has been detected. There has been no exitus until date. The percentage of incontinence is higher in the open surgery group (62.5 vs. 42.9%), while sexual function is more affected in the robotic one.Conclusions: We observed a higher percentage of locally advanced disease in robotic surgery patients, associated with an increase in positive surgical margins in this group (p=0.01). PSMs were not related to PSA persistence. A trend to a greater rate of complications was seen in open surgery.

Keywords:

Salvage radical prostatectomy; Salvage robotic-assisted laparoscopic prostatectomy; Prostate neoplasm; Brachytherapy; Biochemical progression

Cite the Article:

Fajardo-Paneque M, Congregado-Ruiz B, Conde-Sánchez JM, Medina-López RA. Salvage Robotic Prostatectomy after Brachytherapy. Clin Oncol. 2016; 1: 1104.