Evaluating cancer outcomes and safety of laparoscopic prostatectomy in patients with recurrent prostate cancer

The present study evaluated the safety, adverse effects and cancer outcomes of Salvage Robotic Assisted Laparoscopic Radical Prostatectomy (sRALP) in patients with recurrent prostate cancer. The procedure was surgically safe, yet 18% of the patients had another recurrence within 16 months of surgery.

Prostate cancer is the most common type of cancer in men. Treatment options include surgery, hormone therapy and different types of radiation therapy. A significant number of patients treated for prostate cancer have recurrences (return of the cancer). The first sign of recurrence is a detectable level of Prostate Specific Antigen or PSA (a protein specific to the prostate gland).  This phenomenon is known as “biochemical failure”. A recurrent prostate cancer (confined to the gland), previously treated with radiation, can now be removed via salvage radical prostatectomy (complete removal of the prostate gland and some of the tissues around it; performed on a recurrent cancer). This procedure can be performed by one of two main techniques: open (traditional) or laparoscopic (minimally invasive surgery done with a video camera through small cuts). In the last decade, laparoscopic prostatectomy has evolved to utilize a robotic system, which translates the surgeon’s hand movements into a more precise robotic action. This study evaluated the safety and efficacy of this technique in men with recurrent prostate cancer. 

The study included 34 men who had undergone sRALP for prostate cancer that reoccurred after prior radiation treatments. The median PSA level before sRALP was 3.86 ng/ml; and most patients had pre-operative Gleason score of 7 or greater (a grade that predicts how fast the cancer may spread). The researchers measured the average time it took until patients had another biochemical failure after sRALP surgery, and evaluated post-operative recovery. Right after sRALP surgery, 39% of the men had excellent urinary function, little complications and short hospitalization. However, after 16 months of follow-up, 18% of patients had biochemical failure (recurrence). If PSA levels took longer to rise there was a 23% lower risk of cancer reoccurrence. Patients with a higher Gleason score at diagnosis had 3.5 times higher risk of biochemical failure. For comparison, other trials have shown that the standard, open radical prostatectomy, provides a recurrence-free survival rate (living men without biochemical failure) of 48% and a metastasis-free survival rate of 83% (living men without spreading of their cancer) at 5 years after surgery.

The authors of this study concluded that sRALP is safe for patients with recurrent prostate cancer and that is has many favorable outcomes compared to open salvage prostatectomy. On the other hand, the rate biochemical failure was quite high only 16 months after surgery. 

The weakness of this study is in the very small number of cases included (34 men), the lack of direct comparison to the standard technique and of long-term follow up on participants. Further studies on larger populations are necessary to confirm these results.