Surgical removal with radical prostatectomy has been a cornerstone for the treatment of prostate cancer and is associated with level one evidence for survival advantage compared to watchful waiting. Since the first structured robotic program was launched in 2000, robot-assisted radical prostatectomy (RARP) has had a rapid diffusion and surpassed its open (ORP) and laparoscopic (LRP) counterparts in the United States and is progressively expanding in other countries. Interestingly, this common acceptance of RARP was initially driven in the paucity of robust clinical evidence. There is still lack of level one evidence with prospective randomized trials on the oncologic outcomes of RARP. In that scenario, the clinician has to rely on retrospective data and systemic and meta-analyses. In comparison with ORP and LRP, RARP has proven to reach at least equivalent oncological outcomes. Lower rate of PSMs may probably be achieved with RARP in pT2 patients. Although urologists were initially reluctant to embrace RARP in high-risk patients and lymph node yield was low, contemporary series have revealed that RARP and extended lymphadenectomy may be safely performed with obtaining similar (or better) nodal yields, as compared to ORP. Surgeon experience is universally of utmost importance in obtaining good outcomes. We will need to wait for long-term results of contemporary series to comprehend the impact of RARP on CSS and overall survival. Using novel imaging prior to surgery and frozen-section analysis during surgery may allow for superior oncological outcomes.
Journal of endourology. 2017 Jan 11 [Epub ahead of print]
Ali Riza Kural, Can Obek, Tünkut Doğanca
Acibadem Universitesi, 162328, Urology, Istanbul, Turkey ; ., Acibadem Taksim Hospital, Urology, Istanbul, Turkey ; ., Acibadem Taksim Hospital, Urology, Istanbul, Turkey ; .