Introduction:

The use of salvage open- radical prostatectomy (SRP) has not been studied in patients whose primary treatment, Robotic- assisted Laparoscopic prostatectomy (RALP), had failed. The aim of this study is to report our primary experience regarding technical feasibility and safety of salvage open radical prostatectomy (SRP) after robotic assisted laparoscopic prostatectomy (RALP).

Methods:

We retrospectively reviewed the medical records of five patients (n=5) who had undergone SRP after RALP failure for clinically localized prostate cancer evidenced on imaging.

Results:

The patients’ ages ranged from 53.1 to 65.4. They presented to us with raising PSA at their 1st post-RALP check. The median (IQR) post-RALP PSA was 1.98 (1.64 - 10) ng/ml with median (IQR) doubling time of 4 (1.8 -16.9) months. Patients underwent cross-sectional imaging (CT) and pelvic magnetic resonance imaging (MRI) that confirmed presence of residual prostatic tissue. Retropubic open salvage radical prostatectomy (SRP) was performed with no peri-operative or post-operative complications. One patient has reported mild/moderate stress incontinence since his original RALP which he managed by pelvic exercises. The median follow-up duration was 7.8 years. Only one patient required the addition of adjuvant salvage treatment after 9.3 yrs. for signs of cancer progression as evidenced on imaging and by rising PSA.

Conclusion:

In this small case series, SRP was a safe and technically feasible option for management of locally recurrent prostate cancer with residual prostate left behind during primary RALP. Prolonged follow up and further studies are warranted to validate our findings.

Funding: N/A