{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:34:32Z","timestamp":1785530072341,"version":"3.56.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background\/Objectives<\/jats:title>\n                    <jats:p>Targeted High-Intensity Focused Ultrasound (HIFU) is an emerging treatment option for localized prostate cancer (PCa), aiming to balance oncological control with functional preservation. However, data on the feasibility and outcomes of salvage robotic-assisted radical prostatectomy (sRARP) after targeted HIFU remain limited. This study aimed to evaluate feasibility, functional and early oncological outcomes of sRARP in this specific setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Among 112 men treated with targeted HIFU for localized prostate cancer, 15 underwent sRARP between June 2022 and June 2025. The primary outcome was surgical feasibility and safety, assessed by conversion rate, operative time, nerve-sparing approach, lymphadenectomy, positive surgical margins (PSM) at frozen section and final pathology, and intraoperative complications. Secondary outcomes included urinary continence (full or social continence at 1 year), erectile function (with or without phosphodiesterase type 5 inhibitors at 1 year), PSA levels at 45 days and one year after surgery, and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All procedures were completed robotically without intraoperative complications or conversions. Bilateral nerve-sparing was performed in 13 patients (87%). PSM were found in three (20%) patients at frozen section and in two patients (13%) at final pathology; one patient (11%) had lymph node metastases. Early complications occurred in three patients (20%), with only one Clavien Dindo grade \u22653 event. At 1-year follow-up, one patient (8%) had PSA &amp;gt;0.2 ng\/mL; nine patients (75%) were continent and six (50%) reported preserved erectile function. The median follow-up was 14 months (IQR 10.8\u201316.5; 95% CI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>sRARP after targeted HIFU is feasible and safe, with favorable early oncological and functional outcomes. These findings suggest that targeted HIFU may be a viable option in selected patients, without compromising future curative strategies in case of recurrence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1711853","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:21:51Z","timestamp":1770355311000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Salvage robotic-assisted radical prostatectomy after targeted high-intensity focused ultrasound: a single-center study on feasibility, oncological and functional outcomes"],"prefix":"10.3389","volume":"16","author":[{"given":"Ludovica","family":"Cella","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Fasulo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Moretto","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]},{"name":"Urology Service, Assistance Publique \u2013 H\u00f4pitaux de Paris (AP-HP), Hopital Tenon, Assistance-Publique Hopitaux de Paris, Sorbonne Universite","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Beatrici","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Piccolini","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Paolo","family":"Avolio","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Maffei","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Contieri","sequence":"additional","affiliation":[{"name":"Uro-Gynecological Department, Istituto Nazionale Tumori di Napoli, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) \u201cG. Pascale\u201d","place":["Naples, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Tallari","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Mallia","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Uleri","sequence":"additional","affiliation":[{"name":"Department of Urology, Josep Trueta Hospital","place":["Girona, Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Saita","sequence":"additional","affiliation":[{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Hurle","sequence":"additional","affiliation":[{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Casale","sequence":"additional","affiliation":[{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Paciotti","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicol\u00f2 Maria","family":"Buffi","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Lughezzani","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences, Humanitas University","place":["Milan, Italy"]},{"name":"Department of Urology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS) Humanitas Research Hospital","place":["Milan, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2016.08.003","article-title":"EAU-ESTRO-SIOG guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent","volume":"71","author":"Mottet","year":"2017","journal-title":"Eur Urol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.eururo.2018.01.001","article-title":"Focal therapy in primary localised prostate cancer: the European association of urology position in 2018","volume":"74","author":"van der Poel","year":"2018","journal-title":"Eur Urol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60594-6","article-title":"Focal therapy meets prostate cancer","volume":"376","author":"Lazzeri","year":"2010","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1089\/end.2009.0596","article-title":"Focal therapy in prostate cancer\u2014Report from a consensus panel","volume":"24","author":"de la Rosette","year":"2010","journal-title":"J Endourol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2024.10.005","article-title":"Robot-assisted radical prostatectomy with the Hugo RAS and da Vinci surgical robotic systems: A systematic review and meta-analysis of comparative studies","author":"Marino","year":"2024","journal-title":"Eur Urol Focus"},{"key":"B6","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.euros.2025.05.012","article-title":"Preoperative risk factors for failure after fixed sling implantation for postprostatectomy stress urinary incontinence (FORESEE): A systematic review and meta-analysis","volume":"77","author":"Sacco","year":"2025","journal-title":"Eur Urol Open Sci"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2013.05.048","article-title":"The role of focal therapy in the management of localised prostate cancer: A systematic review","volume":"66","author":"Valerio","year":"2014","journal-title":"Eur Urol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2018.06.006","article-title":"A multicentre study of 5-year outcomes following focal therapy in treating clinically significant nonmetastatic prostate cancer","volume":"74","author":"Guillaumier","year":"2018","journal-title":"Eur Urol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2022.01.005","article-title":"Cancer control outcomes following focal therapy using high-intensity focused ultrasound in 1379 men with nonmetastatic prostate cancer: A multi-institute 15-year experience","volume":"81","author":"Reddy","year":"2022","journal-title":"Eur Urol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15102727","article-title":"Salvage radical prostatectomy after primary focal ablative therapy: A systematic review and meta-analysis","volume":"15","author":"Blank","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00345-016-1782-x","article-title":"Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project","volume":"34","author":"Postema","year":"2016","journal-title":"World J Urol"},{"key":"B12","volume-title":"Manual for the State-Trait Anxiety Inventory (Form Y): Self-Evaluation Questionnaire","author":"Spielberger","year":"1983"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(97)00238-0","article-title":"The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction","volume":"49","author":"Rosen","year":"1997","journal-title":"Urology"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5347(17)36966-5","article-title":"The American urological association symptom index for benign prostatic hyperplasia","volume":"148","author":"Barry","year":"1992","journal-title":"J Urol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1016\/S0090-4295(00)00858-X","article-title":"Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer","volume":"56","author":"Wei","year":"2000","journal-title":"Urology"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"470.e19","DOI":"10.1016\/j.urolonc.2025.03.012","article-title":"Enhanced diagnostic accuracy of micro-ultrasound in prostate cancer detection: An updated series from a single-center prospective study","volume":"43","author":"Avolio","year":"2025","journal-title":"Urol Oncol Semin Original Invest"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1038\/s41391-025-01005-3","article-title":"Prostate specific membrane antigen focal ablation imaging (PSMA-FAB)","author":"Lopci","year":"2025","journal-title":"Prostate Cancer Prostatic Dis"},{"key":"B19","unstructured":"Focal One"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/bju.15311","article-title":"Objective assessment of intraoperative skills for robot-assisted radical prostatectomy (RARP): results from the ERUS Scientific and Educational Working Groups Metrics Initiative","volume":"128","author":"Mottrie","year":"2021","journal-title":"BJU Int"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/S1040-8428(02)00024-0","article-title":"Laparoscopic radical prostatectomy: assessment after 550 procedures","volume":"43","author":"Guillonneau","year":"2002","journal-title":"Crit Rev Oncol Hematol"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.eururo.2020.03.023","article-title":"External validation of the 2019 Briganti nomogram for the identification of prostate cancer patients who should be considered for an extended pelvic lymph node dissection","volume":"78","author":"Gandaglia","year":"2020","journal-title":"Eur Urol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.euo.2023.03.010","article-title":"Development and external validation of a novel nomogram to predict the probability of pelvic lymph-node metastases in prostate cancer patients using magnetic resonance imaging and molecular imaging with prostate-specific membrane antigen positron emission tomography","volume":"6","author":"Vis","year":"2023","journal-title":"Eur Urol Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2017172607","article-title":"68 Ga prostate-specific membrane antigen PET\/CT for primary diagnosis of prostate cancer: complementary or alternative to multiparametric MR imaging","volume":"287","author":"Lopci","year":"2018","journal-title":"Radiology"},{"key":"B25","volume-title":"EAU Guidelines. Edn. presented at the EAU Annual Congress Madrid","year":"2025"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181b13ca2","article-title":"The Clavien-Dindo classification of surgical complications","volume":"250","author":"Clavien","year":"2009","journal-title":"Ann Surg"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1111\/iju.12392","article-title":"Artificial urinary sphincter for post-prostatectomy incontinence: A review","volume":"21","author":"James","year":"2014","journal-title":"Int J Urol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"3021","DOI":"10.3390\/jcm12083021","article-title":"Transalbugineal artificial urinary sphincter: A refined implantation technique to improve surgical outcomes","volume":"12","author":"Sacco","year":"2023","journal-title":"J Clin Med"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.23736\/S2724-6051.24.05848-8","article-title":"Impact of a structured rehabilitation program on urinary continence in patients with intermediate high-risk prostate cancer undergoing robotic-assisted laparoscopic prostatectomy","volume":"76","author":"Avolio","year":"2024","journal-title":"Minerva Urol Nephrol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2016.04.040","article-title":"Minimally invasive salvage prostatectomy after primary radiation or ablation treatment","volume":"94","author":"Linares Espin\u00f3s","year":"2016","journal-title":"Urology"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2012.04.014","article-title":"Salvage laparoscopic radical prostatectomy following high-intensity focused ultrasound for treatment of prostate cancer","volume":"80","author":"Leonardo","year":"2012","journal-title":"Urology"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2017.05.071","article-title":"Effect of prior focal therapy on perioperative, oncologic and functional outcomes of salvage robotic assisted radical prostatectomy","volume":"198","author":"Nunes-Silva","year":"2017","journal-title":"J Urol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2010.10.080","article-title":"Salvage radical prostatectomy following primary high intensity focused ultrasound for treatment of prostate cancer","volume":"185","author":"Lawrentschuk","year":"2011","journal-title":"J Urol"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.euf.2021.10.005","article-title":"Outcomes of salvage robot-assisted radical prostatectomy after focal ablation for prostate cancer in comparison to primary robot-assisted radical prostatectomy: A matched analysis","volume":"8","author":"Bhat","year":"2022","journal-title":"Eur Urol Focus"},{"key":"B36","doi-asserted-by":"publisher","first-page":"2995","DOI":"10.1007\/s11701-023-01738-0","article-title":"Outcomes of salvage robot-assisted radical prostatectomy in patients who had primary focal versus whole-gland ablation: a multicentric study","volume":"17","author":"Bhat","year":"2023","journal-title":"J Robot Surg"},{"key":"B37","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.euros.2021.03.003","article-title":"Salvage versus primary robot-assisted radical prostatectomy: A propensity-matched comparative effectiveness study from a high-volume tertiary centre","volume":"27","author":"Nathan","year":"2021","journal-title":"Eur Urol Open Sci"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1711853\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T05:21:53Z","timestamp":1770355313000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2026.1711853\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,6]]},"references-count":37,"alternative-id":["10.3389\/fonc.2026.1711853"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2026.1711853","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,6]]},"article-number":"1711853"}}