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Page 6 of 8 De Luca et al. Mini-invasive Surg 2022;6:13 https://dx.doi.org/10.20517/2574-1225.2021.127

DISCUSSION
In case of local recurrence post-HIFU ablation, sRP is a treatment option for selected patients; however,
there is a paucity of data concerning the perioperative, functional, and oncological outcomes of this
procedure.

Literature about salvage RP after HIFU treatment is very limited and characterized by small series reporting
heterogeneous populations including patients submitted to whole gland ablation and focal ablation [13-15,22,23] .
Furthermore, the available studies concern a number of very different radical prostatectomy techniques (i.e.,
open, laparoscopic, and robotic).

A multi-institutional study by Marconi et al. , presented the largest published series of sRARP in men
[22]
experiencing recurrent disease after focal therapy (defined as the ablation of the index lesion using different
energy sources) for PCa. The authors demonstrated that sRARP post focal therapy was safe and had
excellent urinary continence outcomes (83.1%), using a very strict continence definition (i.e., the use of no
pads). These data are very similar to our series in which we observed 81.1% of urinary continence rate at 12
months.

However, it must be emphasized that our case report involved patients operated by a very experienced
surgeon in a high-volume center. The achievement of such postoperative functional outcomes may not be
reached in situations that do not reflect these requirements, therefore the recommendation of performing
sRARP remains the prerogative of a few select centers.

[22]
Moreover, in Marconi et al. ’s cohort, a high rate of biochemical recurrence was observed post-surgery,
leading to a multimodal treatment approach in a considerable number of patients (41.1%).

The authors observed that men experiencing an infield recurrence post-focal therapy had almost 5 times the
chance of developing recurrence post sRARP, independent of the margin status, Gleason score, or pT stage.

In the present study, biochemical recurrence at 12 months was observed in only one patient, but it is
important to underline the short oncological follow up.

In a retrospective matched pair analysis, the functional and oncological outcomes of sRARP, following
recurrent disease after focal therapy (mostly HIFU), were compared with men undergoing RP as a primary
treatment . In this series, 53% of the patients submitted to sRARP were continent, using the “no pad”
[23]
definition, and 31.8% presented with biochemical recurrence after surgery. When sRARP patients were
matched with 44 patients undergoing primary RARP, no difference in urinary continence, perioperative
outcomes, and complication rates were found. However, sRARP patients demonstrated a 4.8-fold increased
risk of biochemical recurrence when compared to primary RARP patients .
[23]
Thompson et al. demonstrated that patients undergone sRARP post-partial ablation of the prostate using
[14]
HIFU had acceptable perioperative outcomes overall, but with higher than expected rates of anastomotic
leaks and bladder neck contractures. The continence rate was quite low (66%) and the significant positive
surgical margins (SM) rate was high (26%), possibly, according to the authors, as a result of a greater
proportion of focal re-treatments pre-sRARP in their series. No patient recovered erectile function at 3- or
12-month post-sRARP .
[14]