Recent Advances in Radical Prostatectomy: A Narrative Review of Surgical Innovations and Outcomes

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2025 Mar 13

PMID 40075749

Authors

Seon Beom Jo

Jong Wook Kim

Affiliations

Soon will be listed here.

Abstract

Prostate cancer is one of the most commonly diagnosed malignancies worldwide and is a major cause of cancer-associated morbidity in men. Radical prostatectomy (RP) is a cornerstone of intervention for organ-confined diseases and offers a potentially curative outcome. In recent decades, RP has undergone transformative changes, moving from open surgery, with significant morbidity, to minimally invasive and robot-assisted techniques. These advances have improved surgical precision, reduced blood loss, and accelerated functional recovery. Key enhancements, such as the "Veil of Aphrodite", hood-sparing, and Retzius-sparing approaches, aim to preserve neurovascular structures vital for continence and sexual function, addressing the persistent challenge of balancing oncological control with quality-of-life outcomes. Single-port (SP) robotic platforms represent the latest frontier, offering various access routes, including extraperitoneal, transvesical, transperitoneal, and transperineal routes, to further reduce incisional morbidity. Early experiences with SP robot-assisted radical prostatectomy(RARP) suggest favorable continence rates and short hospital stays, although concerns remain regarding the technical complexity and potential margin status of the advanced disease. Comparisons across these techniques revealed broadly similar long-term oncological outcomes, underscoring the importance of patient selection, tumor staging, and surgeon expertise. Ongoing innovations in robotic systems, augmented imaging modalities, and personalized surgical planning are likely to refine prostate cancer care and enhance both survival and post-treatment quality of life.

References

Ramos-Carpinteyro R, Ferguson E, Chavali J, Geskin A, Soputro N, Kaouk J . Single-port Transvesical Robot-assisted Radical Prostatectomy: The Surgical Learning Curve of the First 100 Cases. Urology. 2023; 178:76-82. DOI: 10.1016/j.urology.2023.05.027. View

Lovegrove C, Novara G, Mottrie A, Guru K, Brown M, Challacombe B . Structured and Modular Training Pathway for Robot-assisted Radical Prostatectomy (RARP): Validation of the RARP Assessment Score and Learning Curve Assessment. Eur Urol. 2015; 69(3):526-35. DOI: 10.1016/j.eururo.2015.10.048. View

Lepor H, Gregerman M, Crosby R, Mostofi F, Walsh P . Precise localization of the autonomic nerves from the pelvic plexus to the corpora cavernosa: a detailed anatomical study of the adult male pelvis. J Urol. 1985; 133(2):207-12. DOI: 10.1016/s0022-5347(17)48885-9. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Patel V, Abdul-Muhsin H, Schatloff O, Coelho R, Valero R, Ko Y . Critical review of 'pentafecta' outcomes after robot-assisted laparoscopic prostatectomy in high-volume centres. BJU Int. 2011; 108(6 Pt 2):1007-17. DOI: 10.1111/j.1464-410X.2011.10521.x. View

Hu J, Gu X, Lipsitz S, Barry M, DAmico A, Weinberg A . Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA. 2009; 302(14):1557-64. DOI: 10.1001/jama.2009.1451. View

Galfano A, Di Trapani D, Sozzi F, Strada E, Petralia G, Bramerio M . Beyond the learning curve of the Retzius-sparing approach for robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of the first 200 patients with ≥ 1 year of follow-up. Eur Urol. 2013; 64(6):974-80. DOI: 10.1016/j.eururo.2013.06.046. View

Galfano A, Ascione A, Grimaldi S, Petralia G, Strada E, Bocciardi A . A new anatomic approach for robot-assisted laparoscopic prostatectomy: a feasibility study for completely intrafascial surgery. Eur Urol. 2010; 58(3):457-61. DOI: 10.1016/j.eururo.2010.06.008. View

Davis J, Kreaden U, Gabbert J, Thomas R . Learning curve assessment of robot-assisted radical prostatectomy compared with open-surgery controls from the premier perspective database. J Endourol. 2013; 28(5):560-6. PMC: 3995359. DOI: 10.1089/end.2013.0534. View

10.

Olivero A, Galfano A, Piccinelli M, Secco S, Di Trapani D, Petralia G . Retzius-sparing Robotic Radical Prostatectomy for Surgeons in the Learning Curve: A Propensity Score-matching Analysis. Eur Urol Focus. 2020; 7(4):772-778. DOI: 10.1016/j.euf.2020.03.002. View

11.

Coelho R, Chauhan S, Palmer K, Rocco B, Patel M, Patel V . Robotic-assisted radical prostatectomy: a review of current outcomes. BJU Int. 2009; 104(10):1428-35. DOI: 10.1111/j.1464-410X.2009.08895.x. View

12.

Eichelberg C, Erbersdobler A, Michl U, Schlomm T, Salomon G, Graefen M . Nerve distribution along the prostatic capsule. Eur Urol. 2006; 51(1):105-10. DOI: 10.1016/j.eururo.2006.05.038. View

13.

Dalela D, Jeong W, Prasad M, Sood A, Abdollah F, Diaz M . A Pragmatic Randomized Controlled Trial Examining the Impact of the Retzius-sparing Approach on Early Urinary Continence Recovery After Robot-assisted Radical Prostatectomy. Eur Urol. 2017; 72(5):677-685. DOI: 10.1016/j.eururo.2017.04.029. View

14.

Sood A, Abdollah F, Menon M . Retzius-sparing robot-assisted radical prostatectomy. BJU Int. 2018; 123(1):7-8. DOI: 10.1111/bju.14518. View

15.

Fonseca J, Froes G, Moraes-Fontes M, Rebola J, Lucio R, Almeida M . Urinary continence recovery after Retzius-sparing robot-assisted radical prostatectomy in relation to surgeon experience. J Robot Surg. 2023; 17(5):2503-2511. PMC: 10492722. DOI: 10.1007/s11701-023-01687-8. View

16.

Student Jr V, Vidlar A, Grepl M, Hartmann I, Buresova E, Student V . Advanced Reconstruction of Vesicourethral Support (ARVUS) during Robot-assisted Radical Prostatectomy: One-year Functional Outcomes in a Two-group Randomised Controlled Trial. Eur Urol. 2016; 71(5):822-830. DOI: 10.1016/j.eururo.2016.05.032. View

17.

Abou Zeinab M, Beksac A, Ferguson E, Kaviani A, Kaouk J . Transvesical versus extraperitoneal single-port robotic radical prostatectomy: a matched-pair analysis. World J Urol. 2022; 40(8):2001-2008. DOI: 10.1007/s00345-022-04056-6. View

18.

Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M . Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009; 55(5):1037-63. DOI: 10.1016/j.eururo.2009.01.036. View

19.

Hikita K, Honda M, Shimizu R, Nishikawa R, Teraoka S, Kimura Y . Advanced Reconstruction of Vesicourethral Support May Improve Urinary Continence and Quality of Life After Non-nerve-sparing Robot-assisted Radical Prostatectomy. In Vivo. 2023; 37(1):371-377. PMC: 9843809. DOI: 10.21873/invivo.13088. View

20.

Deng W, Jiang H, Liu X, Chen L, Liu W, Zhang C . Transvesical Retzius-Sparing Versus Standard Robot-Assisted Radical Prostatectomy: A Retrospective Propensity Score-Adjusted Analysis. Front Oncol. 2021; 11:687010. PMC: 8165391. DOI: 10.3389/fonc.2021.687010. View