Feasibility and Early Outcomes of Salvage Robot-Assisted Radical Prostatectomy After Focal Therapy Failure for Localized Prostate Cancer

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 8 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 focal therapy 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.