Endovideosurgical methods for treatment of local prostate cancer: Comparative functional and oncological results

Abstract

Introduction:

Currently, robot-assisted radical prostatectomy (RARP), extraperitoneal radical prostatectomy (ERPE), and laparoscopic radical prostatectomy (LRP) are frequently used for the treatment of localized prostate cancer.

Materials and methods:

The study included 2,290 patients with localized prostate cancer. All patients underwent radical prostatectomy (RPE) performed by a single surgeon using different surgical approaches: robot-assisted (RARP, n = 888), laparoscopic (LRP, n = 965), and extraperitoneal (ERPE, n = 437). Oncological outcomes were assessed based on postoperative PSA levels. Functional status was assessed using the following questionnaires: IIEF-5, ICIQ-SF, DRIP-test, and 24-h pad test.

Results:

In the NS group (LRP and RARP access), the operative time was (200.0 [180.0; 225.0] vs 180.0 [135.0; 230.0] min; p < 0.0001), and the volume of blood loss was (300.0 [200.0; 350.0] vs. 200.0 [150.0; 250.0]). According to the ICIQ-SF test, the presence of patients with symptoms of severe to moderate urinary incontinence (ICIQ-SF scale) in the early postoperative period (mean 9.0 [4.0; 14.0] for RARP vs 11.0 [5.0; 16.0] for LRP and 12.0 [11.0; 14.0] for ERPE, p < 0.0001) contrasted with the results 12 months after surgery, where only patients with mild to moderate urinary incontinence remained (mean 1.0 [0.0; 5.0] for RARP, 4.0 [2.0; 7.0] for LRP, and 5.0 [3.0; 8.0] for ERPE, p < 0.0001).

Postoperative erectile function results were evaluated at 12, 24, and 36 months. In all three groups without the NS technique, all patients had significant erectile dysfunction (p < 0.0001). In contrast, at a median follow-up of 12 months, the postoperative questionnaire results for RARP using the NS technique averaged 14.0 [10.0; 18.0], and for LRP 9.0 [6.0; 11.0] (p < 0.0001).

Conclusion:

Robot-assisted radical prostatectomy is the preferred method as it provides better functional outcomes. The use of the nerve-sparing technique significantly improved outcomes in terms of urinary continence and also resulted in fewer patients requiring urological pads.