Abstract
OBJECTIVES: We aim to compare salvage robotic radical prostatectomy (sRRP) for recurrent prostate cancer (PCa) after primary radiation (RT) versus focal therapy (FT). MATERIALS AND METHODS: Patients who underwent sRRP following primary local therapy for PCa were identified. Perioperative findings and functional/oncologic outcomes were compared in RT versus FT groups. RESULTS: Overall, 112 patients were included, with 84 receiving RT and 28 FT as primary treatment. Median age and PSA were 68 years and 5.4 ng/mL, respectively. There was one rectal injury in the RT group. The overall 90-day complications were significantly higher in RT group (33% vs. 11%, p = 0.03). On multivariable analysis, history of RT and prolonged operative time were associated with a higher rate of 90-day complications. The 6- and 12-month continence rates were higher in FT group (50% vs. 20%, p = 0.02 and 69% vs. 33%, p = 0.03). Potency at 12 months was better preserved in FT group (46% vs. 12%, p = 0.01). On final sRRP pathology, the rates of grade group ≥ 4 (51% vs. 36%, p = 0.2), pT3 (69% vs. 75%, p = 0.6), positive nodes (30% vs. 18%, p = 0.2) and positive margins (33% vs. 39%, p = 0.5) were similar for RT versus FT, respectively. The 3-year biochemical recurrence-free survival was 86% for RT versus 94% for FT (p = 0.6).Conclusion: sRRP for recurrent PCa after FT is associated with lower complications and higher urinary continence and potency rates than patients who received primary RT.