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Partial prostatectomy in prostate cancer: a systematic review of current evidence
Caio Mazzonetto Teófilo de Moraes1, Catharina Lyra2, Alice Matos Fontes3
1Hospital das Clínicas da Universidade de São Paulo (HCUSP), São Paulo, SP, Brazil.
Objective:
To evaluate the current evidence in the literature about partial prostatectomy as a treatment for localized prostate cancer.
Methods:
A systematic search of nine databases was conducted up to December 2024 to identify studies involving patients with localized prostate cancer who underwent partial prostatectomy reporting clinical epidemiological characteristics, diagnostic strategies, histopathological findings, tumor staging, functional and oncological outcomes. The primary outcome was biochemical recurrence rate. Secondary outcomes were overall survival, disease-free survival, erectile dysfunction, urinary incontinence, and perioperative complications. The extracted data were systematically synthesized.
Results:
The authors analyzed five studies with a total of 48 patients (three prospective and two retrospective), all with low- or intermediate-risk disease. The mean surgical duration ranged from 129.2 to 208 min, with a single Clavien-Dindo Grade III complication reported. Only one study defined and reported biochemical recurrence, with a rate of 28 %. Urinary continence was preserved in 92 %-100 % of cases, while erectile function in 40 %-100 % ‒ which may represent a point of concern for this procedure. Overall survival and disease-free survival were consistently reported at 100 %. The lack of standardized reporting and the absence of randomized clinical trials prevented the performance of a meta-analysis and hindered the applicability of the findings to clinical practice.
Conclusion:
Randomized clinical trials are still needed to provide stronger evidence regarding partial prostatectomy, as current data remain insufficient to support its routine use. With further research, partial prostatectomy may become an option for patients with favorable and intermediate-risk disease with unilateral lesions and concordance between magnetic resonance imaging and biopsy findings. Until then, radical prostatectomy remains the cornerstone of treatment for this patient profile.
