Clinical and Functional Outcomes of Contemporary Salvage Robotic-Assisted Radical Prostatectomy for Failed Primary Therapy: A Single Institution Review

Background/Objectives: Salvage radical prostatectomy (SRP) is a potentially curative option for recurrent localized prostate cancer after primary radiation or focal therapy, historically limited by technical complexity and poor functional outcomes. This study characterizes contemporary perioperative, oncologic, and functional outcomes of salvage robotic-assisted radical prostatectomy (sRARP) at a single institution over two decades. Methods: We retrospectively reviewed patients undergoing SRP from 01/01/2004 to 06/30/2026, identified via institutional database queries and natural language processing keyword searches with chart confirmation; analysis was restricted to the robotic-assisted subset. Complications within 90 days were graded by the Clavien–Dindo classification. Biochemical recurrence-free survival (bRFS) required freedom from PSA persistence and recurrence (PSA ≥ 0.2 ng/mL, with biochemical recurrence documented in the medical record) and is reported as a proportion. Results: Of 4002 records identified, 30 patients met inclusion criteria; 24 (80%) underwent sRARP. Extraprostatic disease was present in 54% (13/24) and positive margins in 43% (10/23). Within 90 days, 43% (10/23) had a complication (13% grade ≥ III); 30% (7/23) had a later complication, and 4% (1/24) required later urinary diversion. At a median follow-up of 32.1 months, bRFS was 39% (9/23), and 33% (8/24) had PSA persistence. Incontinence rose from 18% (3/17) at diagnosis to 87% (20/23) post-SRP; at longer-term follow-up (27.3 months), 79% (11/14) used ≥1 pad/day. Erectile dysfunction was present in 82% (14/17) at 22.0 months. Additional cancer-directed therapy was given in 50% (12/24). Conclusions: In this small, descriptive series, sRARP was feasible, but only 39% of patients were free of biochemical recurrence and functional burden was substantial. sRARP may represent a treatment option for carefully selected patients with recurrent localized prostate cancer; however, individualized counseling and further multicenter evaluation are essential.