Recent Advances in Radical Prostatectomy: A Narrative Review of Surgical Innovations and Outcomes

Prostate cancer is one of the most commonly diagnosed malignancies worldwide and is a major cause of cancer-associated morbidity in men. Radical prostatectomy (RP) is a cornerstone of intervention for organ-confined diseases and offers a potentially curative outcome. In recent decades, RP has undergone transformative changes, moving from open surgery, with significant morbidity, to minimally invasive and robot-assisted techniques. These advances have improved surgical precision, reduced blood loss, and accelerated functional recovery. Key enhancements, such as the "Veil of Aphrodite", hood-sparing, and Retzius-sparing approaches, aim to preserve neurovascular structures vital for continence and sexual function, addressing the persistent challenge of balancing oncological control with quality-of-life outcomes. Single-port (SP) robotic platforms represent the latest frontier, offering various access routes, including extraperitoneal, transvesical, transperitoneal, and transperineal routes, to further reduce incisional morbidity. Early experiences with SP robot-assisted radical prostatectomy(RARP) suggest favorable continence rates and short hospital stays, although concerns remain regarding the technical complexity and potential margin status of the advanced disease. Comparisons across these techniques revealed broadly similar long-term oncological outcomes, underscoring the importance of patient selection, tumor staging, and surgeon expertise. Ongoing innovations in robotic systems, augmented imaging modalities, and personalized surgical planning are likely to refine prostate cancer care and enhance both survival and post-treatment quality of life.