Robot-Assisted Radical Prostatectomy for Locally Advanced Prostate Cancer: Oncological Potential and Limitations as...

Area of Science:

• Urology
• Oncology
• Surgical Oncology

Background:

• Locally advanced prostate cancer (PCa) management often involves multimodal therapy.
• Long-term outcomes of radical prostatectomy alone for locally advanced PCa are not well-defined.

Purpose of the Study:

• To investigate the efficacy and limitations of robot-assisted radical prostatectomy (RARP) as a standalone treatment for locally advanced prostate cancer.
• To identify predictors of recurrence after RARP in this patient population.

Main Methods:

• Retrospective analysis of 258 patients with locally advanced PCa undergoing RARP between 2012 and 2022.
• Exclusion of patients receiving neoadjuvant or adjuvant therapy.
• Evaluation of biochemical recurrence-free survival (BRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS).

Main Results:

• Median follow-up was 60.6 months; 63.6% had pathological stage ≥ pT3a, and 27.1% had nodal involvement (pN1).
• Five-year BRFS, MFS, and CSS were 36.6%, 88.9%, and 98.3%, respectively.
• Preoperative predictors of poorer outcomes included high PSA, advanced clinical stage, and multiple high-grade biopsy cores. Postoperative predictors included pathological stage, lymphovascular invasion, and nodal involvement.

Conclusions:

• RARP monotherapy can achieve durable cancer control in carefully selected patients with locally advanced prostate cancer.
• Patients with multiple adverse risk factors are less likely to be cured by surgery alone and may need multimodal treatment.
• Risk stratification is crucial for selecting candidates for surgical monotherapy and avoiding overtreatment.