Salvage robot-assisted radical prostatectomy (sRARP) for radiation resistant prostate cancer in a group of initially high risk patients

Authors

  • Nirmal Lamichhane Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
  • Adam S. Dowrick NTNU, Trondheim, Norway
  • Ulrika Axcrona Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
  • Bjørn Brennhovd Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
  • Sophie D. Fosså NTNU, Trondheim, Norway
  • Karol Axcrona Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

DOI:

https://doi.org/10.3126/njc.v1i1.25628

Keywords:

Prostate cancer, salvage surgery, Robot-assisted radical prostatectomy, raditation therapy

Abstract

Introduction: Salvage robot-assisted radical prostatectomy (sRARP) is seen as an attractive option for salvage treatment of radiation therapy -recurrent prostate cancer (PC), thanks in part to the good visualisation that is possible using this modality. However, the results of fewer than 200 salvage sRARPs have been published in the literature. We report the outcomes in a cohort of initially high risk patients of robot-assisted radical prostatectomy as salvage local therapy for radiation-resistant PC in a Scandinavian healthcare setting.

Materials and methods: A retrospective review of the charts of all patients who underwent sRARP for biochemical failure (BCF) after primary radiation treatment for localised PC at a single institution was performed.

Results: Twenty-two patients, median age 67 years (range 57 to 72), had sRARP performed between June 2008 to July 2013. A median follow-up of 26 months (range 2 to 63) was observed. Perioperative complications occurred in 4 patients (18%), with one patient sustaining a rectal injury. Histo-pathological diagnosis was pT2 in three, pT3a in five, pT3b in twelve and pTx in one patient. Ten patients (45%) had a positive surgical margin (PSM). At follow-up, 54 % of patients were free of biochemical progression and 41% were continent.

Conclusions: We showed that salvage RARP is technically feasible in a cohourt of patients with predominantly high risk disease. This study adds to the limited data already in the literature, demonstrating the high frequency of locally advanced (pT3b) PC, a patient group that is usually not included in salvage treatments, as e.g. high frequency ultrasound or salvage brachytherapy. Further, given that the historical barriers to salvage RP with higher rates of rectal injury and poor urinary control no longer seem to be applicable in the modern era, we think that more patients should be considered candidates for this potentially curative salvage treatment of radiation-resistant PC. However, long-term follow-up is needed to confirm if the additional burden on these patients confers to oncological control following the procedure.

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Author Biographies

Nirmal Lamichhane, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

Department of Urology and Department of Surgical Oncology, B.P. Koirala Memorial Cancer Hospital, Bharatpur, Nepal

Adam S. Dowrick, NTNU, Trondheim, Norway

Department of Cancer Research and Molecular Medicine

Ulrika Axcrona, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

Department of Pathology

Bjørn Brennhovd, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

Department of Urology

Sophie D. Fosså, NTNU, Trondheim, Norway

Department of Cancer Research and Molecular Medicine

Karol Axcrona, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway

Department of Urology

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Published

2017-09-26

How to Cite

Lamichhane, N., Dowrick, A. S., Axcrona, U., Brennhovd, B., Fosså, S. D., & Axcrona, K. (2017). Salvage robot-assisted radical prostatectomy (sRARP) for radiation resistant prostate cancer in a group of initially high risk patients. Nepalese Journal of Cancer, 1(1), 21–27. https://doi.org/10.3126/njc.v1i1.25628

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Section

Original Articles