Robotic Salvage Prostatectomy: An Option for Men Whose Prostate Cancer has Returned after Initial Radiation Treatment

• Prostate cancer can be treated with either surgery or radiation therapy. For men who were initially treated with radiation therapy alone, prostate cancer can return in up to 40-50 percent of cases (Zelefsky et al). Prostate cancer recurrence after failed radiation treatment can significantly impact a patient’s quality of life and cause considerable morbidity (unwanted complications) and lifestyle changes. Failed radiation therapy can impact disease progression and affect cancer specific mortality (death).

  For certain patients local salvage therapy represents the only approach with curative potential in this clinical situation. Local salvage therapy comes in the form of surgery, a salvage prostatectomy. This can be a second chance at cure, but can be associated with increased risks and complications.

  Historically, salvage prostatectomy has been associated with major complication rates of 33-50 percent, 15 percent risk for rectal injury and incontinence rates of 58-65 percent following the procedure (Borland et al, Touma et al).

  However, in contemporary salvage robotic prostatectomy (RP) series, expert surgeons reported improvement in the complication rates (Yuh and Wilson et al). These improved results led the urology team at Fox Chase Cancer Center to study if there is a role for salvage robotic surgery in the management of locally recurrent prostate cancer after radiation therapy.

  The urology team at Fox Chase examined our prostate database to assess the clinical effectiveness of salvage robotic prostatectomy compared to standard treatment, open surgery. We found that robotic salvage prostatectomy compares favorably to open surgery. Our overall complication risk was significantly reduced, we had no rectal injury and rate of incontinence is improved when comparing to the literature for salvage surgery. Hospital stay, estimated blood loss and postoperative recovery were also significantly improved.

  Nonetheless, salvage RP remains a technically demanding procedure and is still associated with higher than normal complications rates when compared to standard RP series. The urology team at Fox Chase acknowledges that this is a small series however we have seen excellent results and great patient outcomes. Our surgeons are highly experienced in performing this procedure and can offer this treatment option to patients when appropriate. To learn more or to schedule an appointment with Dr. Viterbo please call 888-369-2427.