Urinary, sexual outcomes and tumor control after robot-assisted laparoscopic radical prostatectomy in localized prostate cancer

This study analyzed the urinary, sexual, and tumor control outcomes of robotic-assisted laparoscopic radical prostatectomy (RARP) over time in patients with localized prostate cancer. The study found that analyzing these three outcomes is beneficial for these patients.

Localized prostate cancer (PCa) is a form of cancer that has not spread beyond the prostate gland. PCa can be treated by surgery, radiation, or hormone therapy. Prostate surgery can be carried out by classic methods (open surgery) or by robotic hands, called robotic-assisted laparoscopic radical prostatectomy (RARP). Short-term results after surgery have favored RARP use over open surgery, reporting longer operating times but less blood loss during surgery and shorter length of hospital stay. 

However, long-term effects of RARP such as urinary continence (UC; ability to control urine without leakage), erectile function (EF; ability to maintain an erection for sex), and cancer control have not been widely investigated. These 3 are the most desired outcomes following RARP and are called a trifecta.

This study involved 291 patients who were treated with RARP surgery. Trifecta (all 3 outcomes) were evaluated every 3 months up to 1 year.

Trifecta was achieved in 4.6% of patients at 3 months, 5.6% of patients at 6 months, 8.1% of patients at 9 months, and 9.6% of patients at 12 months.

The continency rate at 3 months was 55.2%, at 6 months was 75.5%, at 9 months was 81.6% and at 12 months was 85%. The EF or potency rate at 3 months was 7.5%, at 6 months was 7.8%, at 9 months was 9.8% and at 12 months was 10.9%.

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. At 3 months, 94.4% of patients were free from BCR, at 6 and 9 months, 93.9% of patients were free from BCR, and at 12 months, 90.9% of patients were from BCR.

This study concluded that over time analysis of trifecta outcomes following RARP is beneficial and should be used when counseling patients with localized PCa.

This study included a small number of participants. Also, the study included only Japanese men. The follow-up period was also short.