Abstract
In patients with high-risk compared with low-risk prostate cancer (PCa), the biochemical recurrence (BCR) risk and the cancer-specific mortality rate are 3 times and 11 times higher, respectively. Therefore, high-risk patients are treated with multimodal approaches, including surgery. But, evidences supporting surgery as a monotherapy and showing optimal results has emerged recently. In a current review comapring robot-assisted radical prostatectomy (RARP) and open RP (radical prostatectomy), similar positive surgical margins and BCR rates, as well as reduced bleeding and the need for transfusion and potential benefits for relief and erectile function recovery were demonstrated. RARP ssems to be a safe and effective option for patients who have high-risk PCa or as the first step in a multimodal strategy. Preservation of neurovascular bundle (NVB) is feasible tn the selected cases and there is a possibility to improve functional outcomes. As for lymph node dissection (LND), its therapeutic role in RARP setting is still to be elucidated. Further longitudinal study is required to assess the long-term benefit of primary RARP in men with high-risk PCa.
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