Evaluating the outcomes of salvage Retzius-sparing robotic-assisted radical prostatectomy

This study investigated the effectiveness and functional outcomes of using the Retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) as a salvage treatment for patients with localized prostate cancer (PCa). The study found that the sRS-RARP approach was associated with good urinary and oncological outcomes in these patients.

Localized PCa is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery, radiation, or hormone therapy. If the cancer returns after initial radiation treatment, the patient can be treated by surgery to remove the prostate and residual cancer. This is known as a salvage radical prostatectomy (RP).

RP can be carried out by classic methods (open surgery) or by robotic hands, called robotic-assisted RP (RARP). Retzius-sparing (RS) is a special type of RARP technique that approaches the prostate from below rather than above or the conventional approach. This technically challenging approach preserves all of the structures located in the front and has been associated with better urinary continence (UC) rates. UC is the ability to hold urine without leaking. Whether RS-RARP approach is effective and improves outcomes when used as a salvage treatment for PCa compared to the standard RARP is unknown.

This study involved 26 patients with PCa. Most patients were initially treated with radiotherapy or cryotherapy (the use of extreme cold to freeze and kill cancer cells). 20 patients were treated with the RS-RARP approach and 6 patients were treated with the standard RARP as salvage treatment. Patients were followed up for an average of 18 months.

25% of patients treated with the RS-RARP approach achieved immediate UC (ability to control urine) compared with 0% in the standard RARP group. After 1 year, UC rates were 100% in the RS-RARP group compared with 44.4% in the standard RARP group.

Biochemical recurrence (BR) was also evaluated. If, after treatment, the prostate-specific antigen (PSA; a protein made by cells of the prostate gland that increases in prostate cancer) levels increased by 2 ng/ml from the lowest value it was considered as evidence of BR. BR rate was 20.0% in the RS-RARP group and 33.3% in the standard RARP group after 18 months. 

Patients treated with the RS-RARP approach also had less blood loss (50 mL) compared to the standard approach (100 mL) and required less surgery time (141.5 minutes vs 199.5 minutes).

This study concluded that RS-RARP was associated with good continence and oncological outcomes as salvage treatment for localized PCa.

The study looked back in time for medical records. The study population was small and was also conducted at a single institution. Further studies at different institutions with larger sample sizes are required to evaluate the benefit of the RS-RARP approach.