Robotic-Assisted laparoscopic radical salvage prostatectomy

Radiation therapy (RT) is an accepted treatment for the management of localized prostate cancer [1], and it is estimated that up to one-third of the prostate cancer patients undergo radiotherapy treatment including external radiotherapy, brachytherapy, or a combination of the two [2]. However, following RT, up to 50 % of patients develop biochemical recurrence (BCR) [3], and RT fails in 20–50 % of men [4] with persistent neoplastic cells found in postirradiation prostate biopsies. Based on these outcomes, approximately 30,000 men will experience recurrent disease following RT each year in the United States [5]. Treatment options for these patients include watchful waiting, androgen deprivation therapy (ADT), or additional local salvage therapy such as radical prostatectomy (RP), radical cystoprostatectomy (CP), cryotherapy, high-intensity focused ultrasound (HIFU), and brachytherapy. Of these options, salvage RP has consistently demonstrated a benefit for long-term disease-free survival [5–9] and is currently the only treatment approach with curative potential for these patients [10]. Salvage RP has historically been performed as an open technique. Here, we review salvage RP for recurrent prostate cancer and compare the open RP approach to minimally invasive robotic-assisted laparoscopic radical prostatectomy (RALP), describing the technique, patient morbidity, and oncologic outcomes.