Oncological Outcomes After Robotic Salvage Radical Prostatectomy in Patients Primarily Treated With Focal Versus Radiation Therapy: A Junior ERUS/YAU Collaborative Study.

[BACKGROUND] To evaluate surgical and cancer-control outcome differences in robotic salvage radical prostatectomy (s-RARP) patients after primary prostate cancer treatment with radiation (RT) versus focal therapy (FT).

[METHODS] The Junior ERUS/Young Academic Urologist Working Group Robotics in Urology conducted a multicentric project to investigate biochemical recurrence-free (BCR), metastases-free (MFS) and overall survival outcomes in s-RARP patients primarily treated with RT versus FT.

[RESULTS] Overall, 439 s-RARP patients qualified for analyses, of which 54% initially received RT with a median time interval between primary cancer treatment and s-RARP of 48 months. Patients with RT more frequently exhibited unfavorable oncological characteristics before s-RARP (PSA, ISUP score), as well as pathological ISUP score (all ≤ 0.01), relative to FT patients. No differences in postoperative complications were observed (p > 0.9). In BCR-free analyses, no significant differences between RT and FT were observed (hazard ratio [HR]: 1.30, p = 0.2). In MFS and OS analyses, patients with RT harbored a higher risk of metastases (HR: 10.1, p < 0.001) and death (HR: 5.1, p = 0.02), relative to FT s-RARP patients, but not after multivariable adjustment. In subgroup analyses of 201 FT patients, 80% received high-intensified focused ultrasound (HIFU). No difference in BCR-free survival was observed for HIFU- versus non-HIFU s-RARP patients (p = 0.9).

[CONCLUSIONS] Important differences in tumor characteristics between RT versus FT s-RARP patients exist. These baseline differences translate into unfavorable short-term MFS- and OS outcomes for RT s-RARP patients.