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Comparison of outcomes of salvage robot‐assisted laparoscopic prostatectomy for post‐primary radiation vs focal therapy
Author(s) -
Onol Fikret Fatih,
Bhat Seetharam,
Moschovas Marcio,
Rogers Travis,
Ganapathi Hariharan,
Roof Shan,
Rocco Bernardo,
Patel Vipul
Publication year - 2020
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14900
Subject(s) - medicine , ablation , prostatectomy , radiation therapy , surgery , urology , complication , biochemical recurrence , salvage therapy , cosmesis , prostate cancer , cancer , chemotherapy
Objectives To compare salvage robot‐assisted laparoscopic prostatectomy ( RALP ) outcomes in patients who underwent radiation and those who underwent focal ablation as primary therapies. Patients and Methods We evaluated 126 patients who underwent salvage RALP between 2008 and 2018. Of these, 94 (74.6%) received radiation and 32 focal ablation (25.4%) as primary therapy. These groups were compared with regard to clinical, oncological and functional outcomes. Kaplan–Meier curves and regression models were used to identify survival estimations and their predictors. Results Before surgery, more patients were potent in the focal ablation group compared to the radiation group (46.9% vs 22.6%; P = 0.013). Peri‐operative characteristics and complication rates were not significantly different between the two groups. Postoperative catheterization duration was shorter in the focal ablation group (mean 10 vs 16 days; P = 0.018). At final pathology, the focal ablation group had higher non‐organ‐confined disease (71% vs 50%; P = 0.042) and positive surgical margin ( PSM ) rates (43.8% vs 17%; P = 0.004) as compared to the radiation group; however, 5‐year biochemical recurrence ( BCR )‐free survival rates were similar (59% vs 56%; P = 0.761). Postoperative 1‐year full (no pads/day) and social (0–1 pad/day) continence rates were significantly higher in the focal ablation as compared to the radiation group (77.3% vs 39.2%, P = 0.002, and 87.5% vs 51.3%, P = 0.002, respectively). Multivariate analyses showed primary focal ablation and nerve‐sparing to be predictors of postoperative continence. Erectile function was preserved in 13% and 27% of preoperatively potent patients in the radiation and focal ablation groups, respectively ( P = 0.435). No predictors were identified for postoperative potency. Conclusions Radiation was associated with inferior functional outcomes after salvage RALP . Focal therapies were associated with higher non‐organ‐confined disease and PSM rates, with no significant difference in short‐term BCR ‐free survival.