MP78-12 ROBOTIC ASSISTED RADICAL PROSTATECTOMY AFTER FOCAL THERAPY: ONCOLOGICAL AND FUNCTIONAL OUTCOMES

Abstract

INTRODUCTION AND OBJECTIVES: Following prostate Focal Therapy(FT), a proportion of patients will develop recurrent disease and, some of them will ultimately require salvage treatment. The toxicity of radical prostatectomy after FT (S-RALP) is not clearly understood. Before widespread clinical adoption of FT, it is imperative to characterize the toxicity of secondary treatments after FT in order to counsel patients, inform clinicians and underpin guideline recommendations. Our aim is to characterize the perioperative, oncologic and functional outcomes after S-RALP. METHODS: We included patients with histological confirmation of residual/recurrent prostate cancer (after FT) within the six months previous to radical prostatectomy. In all patients metastatic disease was excluded with a pelvic MRI, bone scan and/or PET-CT. The primary outcome was Progression Free Survival (PFS), which was defined on the basis of no biochemical relapse (PSA<0.2ng/mL) and no need for additional treatment. Urinary continence was defined very strictly as the use of no pads. A patient was considered potent when there was the self-report of erections hard enough for penetration with or without the use of iPDE5. RESULTS: Between September 2010 and June 2018, 82 patients were submitted to S-RARP after failed FT. Mean age at surgery was 65 =61-69]years Median time from FT to S-RALP was 26.5=16-57] months. Pre S-RARP mean PSA was 8.01 ±3,85. Nerve spare was performed in 75.5% of the patients (bilateral-32.7%; unilateral-36.7%; incremental bilateral-4.1% and; incremental unilateral-2%). After a mean follow up of 13 =5-22] months 83.1% of the patients were fully continent. 32.8% of the patients presented preoperative erectile dysfunction. Overall, 13.9% of patients were potent after surgery. There were no intra-operative complications observed. There were 5(6.1%) postoperative complications (4 Grade 1 and 1 Grade 3b). Median[IQR] blood loss was 400=200-500]mL. The positive margin and biochemical failure rate were 13.4% and 41.5%, respectively. PFS was 73.9%, 48% and 36.2% at 12, 24 and 36 months, respectively. The recurrence rate in the high and intermediate risk groups was 64.3% and 34.4%, respectively. CONCLUSIONS: Robotic Radical Prostatectomy post FT is safe with excellent urinary continence outcomes.