Feasibility and early outcomes of salvage robot-assisted radical prostatectomy after focal therapy failure for localized prostate cancer

Abstract

Background Focal therapy (FT) provides an intermediate treatment option between active surveillance and radical therapy for localized prostate cancer. While local recurrence remains an important clinical concern, and post-treatment anatomical changes may complicate the detection and localization of recurrent lesions. This study aimed to evaluate the feasibility and early outcomes of salvage robot-assisted radical prostatectomy (S-RARP) after FT failure and to explore the potential incremental value of prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) over multiparametric magnetic resonance imaging (mpMRI) for recurrence localization. Methods A retrospective analysis was conducted on eight patients who underwent S-RARP following recurrence after primary FT. Patient demographics, imaging data (mpMRI and PSMA PET/CT), and surgical outcomes were analyzed. Pathological specimens were examined using whole-mount sections. Results This study of 8 patients undergoing S-RARP after FT recurrence found that, despite pathological upgrading and out-of-field recurrence being common at recurrence, the salvage procedure was technically feasible, and was associated with promising early outcomes, including negative surgical margins in all cases, no biochemical recurrence during a median follow-up of 21 months, and recovery of urinary continence. PSMA PET/CT could identify suspicious recurrent lesions that are negative on mpMRI. Conclusions S-RARP appeared to be a technically feasible salvage treatment with promising early oncological and functional outcomes, due to the high incidence of pathological upgrading and multifocal recurrence of FT. PSMA PET/CT may complement mpMRI in post-FT surveillance and may help identify recurrence when mpMRI findings are equivocal or negative.