Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood.

Area of Science:

• Urology
• Oncology
• Surgical Robotics

Background:

• Prostate cancer (PCa) diagnosis often relies on biopsies, which can be inconclusive for clinically suspicious cases.
• Theranostic robot-assisted radical prostatectomy (T-RARP) offers a potential alternative for evaluating and treating such cases.
• Comparing T-RARP with traditional robot-assisted radical prostatectomy (RARP) in patients with suspicious PCa is crucial for understanding its benefits.

Purpose of the Study:

• To evaluate the oncological and functional outcomes of T-RARP in men with clinically highly suspicious prostate cancer (PCa) without prior definitive biopsies.
• To compare these outcomes against a control group of patients who underwent RARP with proven malignant biopsies.

Main Methods:

• A cohort study included men with clinically highly suspicious PCa from February 2016 to December 2020.
• Patients were categorized into groups with previous benign biopsies or no prior biopsies undergoing T-RARP.
• A control group of patients with malignant biopsies treated with RARP was included for comparison.

Main Results:

• T-RARP identified malignancy in approximately 75% of cases, with 25% having benign pathology.
• T-RARP demonstrated oncological advantages including higher pathological T stage, lower Gleason grade, and fewer positive surgical margins.
• Significantly better recovery of functional outcomes (erectile and continence) was observed in the T-RARP group compared to the RARP control group.

Conclusions:

• T-RARP is effective in diagnosing PCa in approximately 75% of clinically suspicious cases, maximizing functional outcome preservation.
• Patients undergoing T-RARP, even with benign final pathology, face a small risk of incontinence (6%) and erectile impairment (10%).
• Informed consent is essential for patients considering T-RARP, detailing potential risks and benefits.