Salvage robotic prostatectomy for radio recurrent prostate cancer: Technical challenges and outcome analysis

Introduction: The published data on salvage robot assisted radical prostatectomy (sRARP) is limited. Our aim was to perform a systematic review of the literature on sRARP after radiation failure in patients with prostate cancer and systematically analyse the available evidence for operative and oncological outcomes. Evidence Acquisition: A systematic review of the literature using Pubmed, Scopus, Cochrane library and ScienceDirect databases was performed in June 2016 using medical subject headings and free-text protocol. The search was conducted by applying the following search terms: salvage therapy, salvage, prostatectomy and robotics. Evidence Synthesis: We report on ten case series including 197 men undergoing sRARP after varying modalities of radiotherapy. Over two thirds are recurrence free at the time of follow-up but with continence rates of only 60% and potency rates of only 26%. Complications requiring intervention are few at 16% though higher than primary RARP. Conclusions: sRARP is increasingly acceptable as a treatment modality to be offered to men who fail initial radiation treatment but should be accompanied by appropriate counselling regarding the potential functional outcomes and complications. Series with longer follow-up will be helpful to assess the durability of oncological outcomes while improvements in patient selection and adaption of meticulous surgical technique around the apex could improve continence rates. The concept of concomitant extended PLND remains an issue for debate and the experience with this approach at the time of sRARP and its benefit need further scrutiny.