Robotic prostatectomy for large-volume prostates in prostate cancer: a retrospective analysis of 50 cases (>100 ml)

To assess the clinical application and efficacy of robotic radical prostatectomy in 50 cases of large-volume (> 100 ml) prostate cancer.

A retrospective analysis was conducted on 50 patients with large-volume (> 100 ml) prostate cancer who underwent robotic radical prostatectomy from June 2020 to August 2023. Patient ages ranged from 55 to 77 years (mean: 66.5 ± 10.5 years). Total PSA levels ranged from 7.9 to 98.5 ng/ml (mean: 18.7 ± 9.3 ng/ml), and the f/t PSA ratio ranged from 0.12 to 0.94 (mean: 0.35 ± 0.21). Gleason scores were: 15 scored 7, 24 scored 8, 10 scored 9, and 1 scored 10. Preoperative evaluations included lab tests, pelvic MRI, and whole-body bone scans. Patients without surgical contraindications underwent robotic radical prostatectomy.

All surgeries were completed without conversion to open surgery or major vascular injuries. Operative time ranged from 80 to 150 min (mean: 105 min). Blood loss ranged from 30 to 450 ml (mean: 110 ml), with no transfusions required. Postoperative hospital stays ranged from 2 to 8 days (mean: 4.5 days). Catheter removal occurred between 3 and 7 days postoperatively (mean: 4 days). Time to first flatus ranged from 1 to 3 days (mean: 1.5 days). Two cases had postoperative lymphatic leakage. Pathology revealed positive surgical margins in 3 cases, with stage distribution of 22 in T2a, 15 in T2b, 7 in T3a, and 6 in T3b; 2 cases had positive lymph nodes. Follow-up ranged from 2 to 26 months (median: 12.5 months). The one-year biochemical recurrence rate was 7.9% (3/38), and the one-year urinary continence satisfaction rate was 92.1% (35/38).

Robotic radical prostatectomy for large-volume prostate cancer, despite its surgical challenges, is a safe and feasible approach. With sufficient surgical experience and case volume, satisfactory outcomes can be achieved.