Robotic radical prostatectomy: a critical analysis of the impact on cancer control

Robot-assisted laparoscopic prostatectomy (RALP) has become the most used surgical procedure to treat clinically localized prostate cancer. Considering its curative intent, the evaluation of the oncologic outcomes must be considered with careful attention. In this review, we summarized and critically discussed the most relevant oncologic data available in the literature about RALP.

Currently, the oncologic effectiveness of RALP procedure can be evaluated looking at surrogate end-points such as positive surgical margins rate, percentage of additional salvage therapies required, and biochemical disease-free survival (bDFS). Available studies comparing RALP and retropubic radical prostatectomy showed that positive surgical margin rates were equivalent or slightly lower following RALP. Moreover, population-based studies showed similar risk in terms of additional salvage therapies between retropubic radical prostatectomy and minimally invasive radical prostatectomy. Moreover, comparative studies with short-term follow-up demonstrated overlapping results also in terms of bDFS. The initial long-term oncologic data (5-year median follow-up) estimated excellent 5-year and 7-year bDFS probabilities after RALP.

Although further studies with long-term follow-up are needed to estimate the main oncologic outcomes (overall and cancer-specific survival), available data supported the oncologic safety of RALP procedure in patients with clinically organ-confined prostate cancer.