Salvage Radical Assisted Laparoscopic Prostatectomy After Low-Dose Rate Brachytherapy

Abstract

Introduction:

The feasibility and outcome of salvage robotic prostatectomy (SRP) following failed low-dose brachytherapy is unknown and historically associated with significant complications. The largest worldwide published series is 22. ¹ The brachytherapy causes intense fibrosis of the prostate/endopelvic fascia, which makes dissection difficult by the traditional open retropubic route, namely blind blunt dissection. Consequently, the complications of this procedure were common with rectal injury being most feared due to dissection of the plane between the prostate and rectum. The dissection of the posterior plane is where the robot is far superior to the open approach. Here, we show you the stages as to how we perform a radically assisted salvage prostatectomy.

Methods:

Five consecutive patients underwent SRP. Inclusion criteria for salvage surgery was defined as >2 ng/mL above the prostate-specific antigen (PSA) nadir ² or rising PSA and confirmed residual prostate cancer on biopsy. All the patients had repeat prostate biopsies, full restaging as per referring hospitals protocol, and choline CT positron emission tomography scan (carried out at University College London) to exclude evidence of metastatic disease.

Results:

The median age was 67 years (range 62–68 years). The median operative time was 164 minutes (range 117–206 minutes). The median blood loss was 70 mL (range 30–200 mL), with zero transfusion rate. The median length of stay was 2 days (range 1–2 days). There were no grade 3 to 5 complications or rectal injuries. With a median follow-up of 10 months, the PSA was unrecordable <0.1 ng/L in four of five men, with the other patient having a 6-week postoperative PSA of 4. All the patients had erectile dysfunction. Eighty percent of men have ICIQ-MLUTs stress incontinence “sometimes” at their 6-month questionnaire.

Conclusion:

SRP provides oncological control with minimal early complications, blood loss, and length of stay with the potential avoidance of systemic noncurative therapy. The long-term continence and quality-of-life issues are still being evaluated.

No competing financial interests exist

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Runtime of video: 6 mins 15 secs