Robot-Assisted versus Open Radical Prostatectomy in the Treatment of Localized Prostate Cancer: 3-Year Results from a...

Radical prostatectomy remains the primary treatment for localized prostate cancer (PCa). Despite its use for over two decades, the benefits of robot-assisted radical prostatectomy (RARP) remain unclear. We evaluated the surgical, functional, and oncological outcomes between RARP and open radical retropubic prostatectomy (RRP).

This prospective cohort study included men who underwent radical prostatectomy between March 2016 and April 2020. We excluded patients who received preoperative androgen-deprivation therapy, had an initial prostate-specific antigen level of >50 ng/mL, had a clinical T stage of ≥T3b, and those aged under 50 or over 80 years. The primary outcome was the 90-day complication rate. Surgical and oncologic outcomes were compared. Continence and potency recovery were depicted using Kaplan-Meier curves and assessed using the log-rank test. To balance baseline characteristics, stabilized inverse probability of treatment weighting (sIPTW) was used.

Among the 1,306 patients assessed, 1,055 were included after exclusion and adjustment using the sIPTW (RARP, n=835; RRP, n=220), with a median follow-up of 39 months. The RARP group had a significantly lower 90-day complication rate than the RRP group (8.9% vs. 26.4%; p<0.001). The RARP group showed significantly better surgical outcomes, including estimated blood loss and surgical margins. At 36 months, the pad-free rates were 86.1% and 88.4% for the RARP and RRP groups, respectively (log-rank test, p=0.642). Potency recovery was superior in the RARP group (11.4% vs. 5.2%; log-rank test, p=0.001). Biochemical recurrence (RARP, 23.7%; RRP, 27.9%; p=0.246) and rates of additional treatment (RARP, 23.5%; RRP, 28.1%; p=0.202) were not different. Single-institution study is a potential limitation.

The findings indicate that RARP is associated with a better safety profile and surgical outcomes without compromising short-term oncologic outcomes than RRP. While continence recovery was comparable between the methods, RARP may offer superior potency recovery.