Salvage robotic-assisted radical prostatectomy in a patient with recurrence after two sessions of heavy ion radiotherapy

Salvage radical prostatectomy is a postradiation treatment for patients with localized prostate cancer. In 2016, Ozu <i>et al.</i> (Ozu C, Aoki K, Nakamura K, Yagi Y, Muro Y, Nishiyama T, <i>et al.</i> The initial case report: salvage robotic assisted radical prostatectomy after heavy ion radiotherapy. <i>Urol Case Rep</i> 2016;<b>7</b>:45-7) first reported salvage robotic-assisted radical prostatectomy (sRARP) after heavy-ion radiotherapy (HIRT). Thereafter, sRARP has been performed in >100 cases. However, it is currently avoided owing to some difficulties. Herein, we report about sRARP in a 67-year-old man who received two sessions of HIRT despite some expected challenges. He was initially treated with HIRT for prostate cancer in 2009 and received the second HIRT as salvage treatment for local recurrence in 2016. In 2019, he had biochemical recurrence and underwent sRARP. There were no significant peri- or postoperative complications. Subsequently, 12 months after sRARP, hormonal therapy was introduced after the diagnosis of biochemical recurrence. The patient's prostate-specific antigen level is currently undetectable.