Evaluating the long-term functional and oncological outcomes after open versus robot-assisted prostate surgery for localized prostate cancer.

This study evaluated the long-term functional and oncological outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP) and open retropubic radical prostatectomy (RRP) for the treatment of patients with localized prostate cancer (PCa). This study found that RALP was associated with better oncological outcomes compared to RRP over the long term.

Localized PCa is a form of cancer that has not spread beyond the prostate gland. It can be treated by surgery, radiation, or hormone therapy. 

RRP or open surgery is a type of prostate surgery in which the prostate gland is removed by a surgeon by making small incisions. RALP is a type of prostate surgery that uses robotic hands to remove the prostate gland with more precision. Patients who undergo RALP surgery commonly have less blood loss and shorter hospital stays. In the short term, patients often have urinary incontinence (UI; involuntary urine leakage) or erectile dysfunction (ED) after this procedure. However, there are few studies comparing the long-term functional and oncological outcomes of RALP and RRP for the treatment of patients with localized PCa.

This study involved 3584 patients with localized PCa. Patients were divided into two groups. 2699 patients underwent RALP.  885 patients underwent RRP. The average follow-up time was 8 years.

The UI rate for the RALP group was 27% compared to 29% for the RRP group. This difference was not statistically significant. ED was significantly less common for the RALP group (66%) compared to the RRP group (70%).

RALP group had a 44% lower risk of mortality due to PCa compared to the RRP group.

Positive surgical margins (PSMs) indicate that some cancer cells have been left behind at the tumor site following surgery. In patients with high-risk PCa, the PSM rate of the RALP group was 21% compared to 34% for the RRP group. 

Biochemical recurrence (BCR) was also evaluated. If, after treatment, the prostate-specific antigen (PSA; a protein made by cells of the prostate gland) levels increased by 0.2 ng/ml from the lowest value it was considered as evidence of BCR. In patients with high-risk disease, BCR was 51% for the RALP group compared to 69% for the RRP group.

This study concluded that RALP was associated with better long-term outcomes compared to RRP for patients with localized PCa.

Patients were not randomly assigned into groups. This study only included patients from Sweden.