Robotic radical prostatectomy in post HIFU salvage setting: tertiary center experience and review of the current literature

Abstract

Aim: The purpose of the study was to describe our surgical technique of salvage robot-assisted radical prostatectomy (sRARP) in patients who underwent primary high-intensity focused ultrasound (HIFU) and to report the perioperative, functional, and oncological outcomes during the first year follow up. The secondary aim of the study was to review the current literature evidence on this topic.

Methods: We retrospectively extracted, from our prospective RARP database, all the patients who underwent sRARP for biochemical recurrence after primary HIFU. All the surgical interventions were performed by a single surgeon following our total anatomical reconstruction (TAR) technique. Demographics, perioperative, functional, and oncological results were collected up to one year follow-up.

Results: Eleven patients underwent post-HIFU sRARP with TAR technique at our institution. All the surgical procedures were uneventful. All the complication recorded were classified as Clavien-Dindo Grade I. Continence rate at 1-, 3-, 6-, and 12-month post intervention was 36.3%, 45.5%, 63.6 %, and 81.1%, respectively. Medium PSA at 12 months follow-up was 0.2 ng/mL (SD 0.01), with no Biochemical Failure (BCF) recorded.

Conclusion: sRARP with TAR technique is a safe and feasible procedure in patients with BCF after primary HIFU. No major complications were recorded, with good oncological and functional results after one year follow up.

Keywords

Prostate cancer, focal therapy / HIFU, safety, salvage therapy, magnetic resonance imaging, PSMA-PET/CT

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