Yaşar BOZKURT, Murat ATAR, Louis L. PISTERS

Early Experience with Salvage Robotic-Assisted Radical Prostatectomy in Proton Beam Radiotherapy Failures

Aims: To assess the perioperative and short-term functional and oncologic outcomes of the salvage robot-assisted radical prostatectomy (sRARP), after recurrence following primary proton beam therapy for clinically localized prostate cancer. Methods: Ten patients undergoing sRARP after failure of the prior definitive proton beam therapy for localized prostate cancer were included. BCR is defined as a prostate-specific antigen (PSA) value of 2.0 ng/mL greater than the absolute nadir. All of the individuals had a diagnosis of prostate cancer via biopsy after proton beam therapy, with negative findings on magnetic resonance imaging/computer tomography of the pelvis and abdomen, and a bone scan. The sRARP procedure with pelvic lymph node dissection was performed by a single surgeon in all patients. Results: The median age of the cohort at sRARP was 66.8 years, and the mean BMI was 29.2 kg/m2 . The mean duration from proton beam therapy to sRARP was 58.4 months; the mean preoperative PSA level was 5.5 ng/mL, the mean operative time was 230 minutes, and the approximate blood loss was 745 mL. Anastomotic leakage occurred in half of the individuals, and bladder neck contracture developed in 6 patients. For 8 patients, the continence results within 6 months followup were available. Overall, 24 complications occurred in 9 patients. At follow-up in the 32nd month, the overall survival rate was 80%, and the BCR-free survival rate was 90%. Conclusion: sRARP after proton beam therapy is an applicable procedure, but has a high risk of serious complications.

PDF

___

1. Jang JW, Drumm MR, Efstathiou JA, et al. Long-term quality of life after definitive treatment for prostate cancer: patient-reported outcomes in the second posttreatment decade. Cancer Med. 2017;6:1827-1836. [CrossRef]
2. Burt LM, Shrieve DC, Tward JD. Factors influencing prostate cancer patterns of care: an analysis of treatment variation using the SEER database. Adv Radiat Oncol. 2018;3:170-180. [CrossRef]
3. Agarwal PK, Sadetsky N, Konety BR, et al. Treatment failure after primary and salvage therapy for prostate cancer: likelihood, patterns of care, and outcomes. Cancer. 2008;112:307-314. [CrossRef]
4. Chade DC, Eastham J, Graefen M, et al. Cancer control and functional outcomes of salvage radical prostatectomy for radiation-recurrent prostate cancer: a systematic review of the literature. Eur Urol. 2012;61:961-971. [CrossRef]
5. Abufaraj M, SiyamA, Ali MR, et al. Functional outcomes after local salvage therapies for radiation-recurrent prostate cancer patients: a systematic review. Cancers (Basel). 2021;13. [CrossRef]
6. Coughlin GD, Yaxley JW, Chambers SK, et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol. 2018;19:1051-1060. [CrossRef]
7. Acar O, Esen T. Robotic radical prostatectomy in patients with previous prostate surgery and radiotherapy. Prostate Cancer. 2014;2014:367675. [CrossRef]
8. Gontero P, Marra G, Alessio P, et al. Salvage radical prostatectomy for recurrent prostate cancer: morbidity and functional outcomes from a large multicenter series of open versus robotic approaches. J Urol. 2019;202:725-731. [CrossRef]
9. Onol FF, Bhat S, Moschovas M, et al. Comparison of outcomes of salvage robotassisted laparoscopic prostatectomy for post-primary radiation vs focal therapy. BJU Int. 2020;125:103-111. [CrossRef]
10. Kenney PA, Nawaf CB, Mustafa M, et al. Robotic-assisted laparoscopic versus open salvage radical prostatectomy following radiotherapy. Can J Urol. 2016;23: 8271-8277.
11. Kamran SC, D'Amico AV. Radiation therapy for prostate cancer. Hematol Oncol Clin North Am. 2020;34:45-69. [CrossRef]
12. Sheets NC, Goldin GH, Meyer AM, et al. Intensity-modulated radiation therapy, proton therapy, or conformal radiation therapy and morbidity and disease control in localized prostate cancer. JAMA. 2012;307:1611-1620. [CrossRef]
13. Dearnaley DP, Jovic G, Syndikus I, et al. Escalated-dose versus control-dose conformal radiotherapy for prostate cancer: long-term results from the MRC RT01 randomised controlled trial. Lancet Oncol. 2014;15:464-473. [CrossRef]
14. Iwata H, Ishikawa H, Takagi M, et al. Long-term outcomes of proton therapy for prostate cancer in japan: a multi-institutional survey of the Japanese radiation oncology study group. Cancer Med. 2018;7:677-689. [CrossRef]
15. Trofimov A, Nguyen PL, Coen JJ, et al. Radiotherapy treatment of early-stage prostate cancer with IMRT and protons: a treatment planning comparison. Int J Radiat Oncol Biol Phys. 2007;69:444-453. [CrossRef]
16. Vargas C, Fryer A, Mahajan C, et al. Dose-volume comparison of proton therapy and intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:744-751. [CrossRef]
17. Rossi CJ, Sung Kim Jr Re, Shunhua S, et al. Late gastrointestinal toxicities following radiation therapy for prostate cancer. Eur Urol. 2011;60:908-916.
18. Dindo D, Hahnloser D, Clavien PA. Quality assessment in surgery: riding a lame horse. Ann Surg. 2010;251:766-771. [CrossRef]
19. Zargar H, Lamb AD, Rocco B, et al. Salvage robotic prostatectomy for radio recurrent prostate cancer: technical challenges and outcome analysis. Minerva Urol Nefrol. 2017;69:26-37. [CrossRef]
20. Calleris G, Marra G, Dalmasso E, et al. Is it worth to perform salvage radical prostatectomy for radio-recurrent prostate cancer? A literature review. World J Urol. 2019;37:1469-1483. [CrossRef]
21. Artibani W, Porcaro AB, De Marco V, Cerruto MA, Siracusano S. Management of biochemical recurrence after primary curative treatment for prostate cancer: a review. Urol Int. 2018;100:251-262. [CrossRef]
22. Bates AS, Samavedi S, Kumar A, et al. Salvage robot-assisted radical prostatectomy: a propensity matched study of perioperative, oncological and functional outcomes. Eur J Surg Oncol. 2015;41:1540-1546. [CrossRef]
23. Gotto GT, Yunis LH, Vora K, et al. Impact of prior prostate radiation on complications after radical prostatectomy. J Urol. 2010;184:136-142. [CrossRef]
24. Mohler JL, Halabi S, Ryan ST, et al. Management of recurrent prostate cancer after radiotherapy: long-term results from CALGB 9687 (Alliance), a prospective multiinstitutional salvage prostatectomy series. Prostate Cancer Prostatic Dis. 2019;22:309-316. [CrossRef]
25. Devos B, Al Hajj Obeid W, Andrianne C, et al. Salvage high-intensity focused ultrasound versus salvage radical prostatectomy for radiation-recurrent prostate cancer: a comparative study of oncological, functional, and toxicity outcomes. World J Urol. 2019;37:1507-1515. [CrossRef]
26. Golbari NM, Katz AE. Salvage therapy options for local prostate cancer recurrence after primary radiotherapy: a literature review. Curr Urol Rep. 2017;18:63. [CrossRef]
27. Eandi JA, Link BA, Nelson RA, et al. Robotic assisted laparoscopic salvage prostatectomy for radiation resistant prostate cancer. J Urol. 2010;183:133-137. [CrossRef]
28. Yuh B, Ruel N, Muldrew S, et al. Complications and outcomes of salvage robotassisted radical prostatectomy: a single-institution experience. BJU Int. 2014;113: 769-776. [CrossRef]
29. Paganetti H, Niemierko A, Ancukiewicz M, et al. Relative biological effectiveness (RBE) values for proton beam therapy. Int J Radiat Oncol Biol Phys. 2002;53: 407-421. [CrossRef]
30. Kaffenberger SD, Keegan KA, Bansal NK, et al. Salvage robotic assisted laparoscopic radical prostatectomy: a single institution, 5-year experience. J Urol. 2013;189: 507-513. [CrossRef]