To describe a revised surgical approach for robotic-assisted laparoscopic radical prostatectomy and evaluate its safety, functional outcomes, urinary symptoms, quality of life, and short-term oncological results.A total of 61 patients at a large university hospital underwent modified maximum peri-prostatic anatomy preserving-robotic assisted laparoscopic radical prostatectomy (MPAP-RALP) from June 2019 to June 2022.The median surgery time and blood loss were 257.0min and 200.0 mL. Three patients had Clavien-Dindo grade II complications, and only one patient had Clavien-Dindo grade III complications. No patients died. 12 (19.7%) patients with surgical margins. 13 (21.3%) and 9 (14.8%) patients had evidence of PSA persistence after 1 month and 6-8 postoperative weeks. Continence rates continued to improve at 1 month (95.1%), 3 months (95.1%), 6 months (96.7%), and 12 months after surgery. No patients had serious urinary symptoms, and 2 (3.3%) patients were dissatisfied after 1 month surgery about quality of life.In conclusion, the modified MPAP-RALP is feasible and can be performed safely by an experienced urologic surgeon. Preliminary evidence suggests that the modified MPAP-RALP facilitates early continence recovery, does not affect surgical margin rates, reduces surgical complications, and enhances quality of life.

BACKGROUND We investigated the potential of the preoperative neutrophil-to-lymphocyte ratio (NLR) and soluble urokinase-type plasminogen activator receptor (suPAR) as predictive biomarkers for biochemical recurrence (BCR) following radical prostatectomy in prostate cancer (PCa). By examining these markers individually and in combination, we aimed to enhance risk stratification and improve postoperative management. MATERIAL AND METHODS A retrospective cohort of 245 patients with PCa who underwent laparoscopic radical prostatectomy were stratified into non-BCR (n=183) and BCR (n=62) groups based on a 2-year follow-up. We collected comprehensive clinical and pathological data, calculated preoperative NLR, and measured serum suPAR using ELISA. Cox regression analysis identified independent risk factors for BCR, while ROC curves evaluated the predictive power of NLR, suPAR, and their combination. Kaplan-Meier survival analysis assessed BCR risk associated with varying levels of these biomarkers. RESULTS Preoperative NLR and suPAR levels were significantly higher in the BCR group. Multivariate Cox regression identified several independent risk factors for BCR, including preoperative PSA ≥20 ng/mL, pathological T3-T4 stage, positive surgical margins, and elevated NLR and suPAR levels. ROC analysis showed NLR and suPAR combined (AUC: 0.943, 95% CI: 0.911-0.975) significantly outperformed the predictive accuracy of each marker alone, with standalone AUCs of 0.873 for NLR and 0.881 for suPAR. CONCLUSIONS Elevated preoperative NLR and suPAR are strongly associated with increased BCR risk after radical prostatectomy in patients with PCa. Combined assessment of these biomarkers offers a superior predictive tool, facilitating personalized risk stratification and potentially guiding tailored postoperative management strategies in PCa care.

Background and Aims: Nutritional risk is a significant yet often overlooked factor influencing postoperative outcomes in older patients with prostate cancer. This study aimed to evaluate the impact of the Geriatric Nutritional Risk Index (GNRI) on postoperative complications in older patients undergoing radical prostatectomy. Secondary objectives included examining the association between the GNRI and healthcare resource utilization, specifically the length of hospital stay and hospitalization costs. Methods: This retrospective cohort study included patients aged ≥ 65 years who underwent laparoscopic radical prostatectomy at a single tertiary center between 2022 and 2024. Patients were stratified into a malnutrition group (GNRI ≤ 98) and a normal nutrition group (GNRI > 98). Clinical outcomes were compared using chi-square and t tests. Binary logistic regression was performed to identify independent predictors of complications, hospital stay, and costs. Results: Of the 264 patients included, 34.8% were classified as being at nutritional risk. The malnutrition group had a significantly higher incidence of postoperative complications (OR = 2.859, p = 0.007), longer hospital stays (OR = 4.678, p < 0.001), and greater hospitalization costs (OR = 4.867, p < 0.001). Nutritional risk remained a significant predictor after adjusting for confounders. Conclusions: GNRI-defined nutritional risk is independently associated with increased postoperative complications and higher healthcare resource utilization in older prostate cancer patients. The GNRI may serve as a practical and accessible tool for perioperative risk stratification in this population.

Post-prostatectomy urinary incontinence significantly impacts quality of life. Techniques that preserve periprostatic structures have shown promise in promoting earlier continence recovery, particularly with robotic-assisted surgery. The study aimed to evaluate the effect of pubovesical complex (PVC) preservation on urinary continence recovery in patients undergoing laparoscopic radical prostatectomy (LRP). In this randomized, blinded, prospective clinical trial, 72 patients with localized prostate cancer were assigned to standard LRP or LRP with PVC preservation. The primary endpoint was urinary continence recovery, defined as complete absence of leakage or pad use, assessed at 24 h, 15 days, 1, 3, and 6 months post-catheter removal. Secondary endpoints included operative time, blood loss, complications, and oncologic outcomes. At 6 months, continence was significantly higher in the PVC group (82.4% vs. 57.6%; p = 0.027). Earlier timepoints showed improved, though not statistically significant, continence rates in the PVC group. Operative time (109 vs. 75 min; p < 0.001) and blood loss (365 vs. 247 ml; p = 0.010) were greater with PVC preservation. Complication and margin positivity rates were similar between groups. PVC preservation during LRP significantly improves urinary continence recovery without compromising oncologic safety. This accessible technique can be adopted in centers lacking robotic platforms, offering equitable benefits for patients in resource-limited settings. Brazilian Clinical Trials Registry (ReBEC), RBR-7f25wsz.

Robot-assisted radical prostatectomy (RARP) has rapidly supplanted conventional laparoscopic radical prostatectomy (LRP), despite the limited high-quality comparative evidence. This systematic review synthesizes randomized controlled trial data comparing RARP with LRP for localized prostate cancer, incorporating the GRADE certainty assessment and pre-planned geographic subgroup analyses.This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420251207193). We conducted a PRISMA-compliant systematic review of MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, and ClinicalTrials.gov through October 2025 for randomized controlled trials comparing RARP with LRP (2D/3D) in men with localized or locally advanced prostate cancer. The primary outcomes were 12-month urinary continence and erectile function scores. Secondary outcomes included perioperative metrics, complications, and positive surgical margins. Random-effects meta-analyses estimated risk ratios (RR) and mean differences (MD) with 95% confidence intervals. The risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was evaluated using the GRADE methodology.Four randomized controlled trials (1095 participants) met the inclusion criteria, with 734 patients in the RARP group and 361 patients in the LRP group. Conventional LRP achieved significantly superior 12-month urinary continence compared to RARP (RR 1.12, 95% CI 1.03-1.22; p = 0.006; I²=0%; moderate-certainty evidence), equivalent to 66 additional continent patients per 1,000 treated. Erectile function recovery at 12 months significantly favored LRP (RR 1.39, 95% CI 1.09-1.76; p = 0.007; I²=0%; moderate-certainty evidence), representing 91 additional potent patients per 1,000 patients. Positive surgical margins did not differ significantly (RR 1.11, 95% CI 0.85-1.44; p = 0.45; low-certainty evidence), supporting equivalent oncological safety. Perioperative outcomes, including operative time (MD 4.18min, 95% CI - 0.51 to 8.87; p = 0.08), estimated blood loss (MD - 26.24 mL, 95% CI - 98.68 to 46.21; p = 0.48; I²=91%), and overall complications (RR 0.94, 95% CI 0.52-1.68; p = 0.83) showed no significant differences. The geographic subgroup analysis suggested potential regional variation, but the tests for interaction were not significant.This randomized evidence synthesis demonstrates that conventional laparoscopic radical prostatectomy was associated with significantly better urinary continence and erectile function at 12 months compared with robot-assisted approaches, while maintaining comparable oncologic and perioperative outcomes. These findings suggest that surgeon expertise and institutional experience may be important determinants of patient outcomes, independent of the technology platform employed.

Minimally invasive surgical approaches are currently the standard of care for men with prostate cancer, presenting higher rates of erectile function preservation. With these laparoscopic techniques, there is an increasing amount of data and information available. Adaptive systems can play an important role, acting as an intelligent information filter, assuring that all the available information can become useful for the procedure and not overwhelming for the surgeon. Standardizing and structuring the surgical workflow are key requirements for such smart assistants to recognize the different surgical steps through context information about the environment. This work aims to do a detailed characterization of a laparoscopic radical prostatectomy procedure, focusing on the formalization of medical expert knowledge, via surgical process modeling. Data were acquired manually, via online and offline observation, and discussion with medical experts. A total of 14 procedures were observed. Both manual laparoscopic radical prostatectomy and robot-assisted laparoscopic prostatectomy were studied. The derived SPM focuses only on the intraoperatory part of the procedure, with constant feedback from the endoscopic camera. For surgery observation, a dedicated Excel template was developed. The final model is represented in a descriptive and numerical format, combining task description with a workflow diagram arrangement for ease of interpretation. Practical applications of the generated surgical process model are exemplified with the creation of activation trees for surgical phase identification. Anatomical structures are reported for each phase, distinguishing between visible and inferable ones. Additionally, the surgeons involved are identified, surgical instruments, and actions performed in each phase. A total of 11 phases were identified and characterized. Average surgery duration is 87min. The generated surgical process model is a first step toward the development of a context-aware surgical assistant and can potentially be used as a roadmap by other research teams, operating room managers and surgical teams.

Transversus abdominis plane (TAP) block is a common analgesic technique in robotic-assisted laparoscopic radical prostatectomy (RALP). However, its necessity in the framework of an opioid-free anesthesia (OFA) strategy has not yet been evaluated. Our aim was to assess if TAP block is essential for optimal pain management under OFA strategy in RALP. A retrospective quasi-experimental study was conducted involving 40 adult patients undergoing RALP between March 2024 and March 2025. All patients received an OFA strategy (continuous intravenous [IV] infusion of lidocaine, dexmedetomidine, and ketamine). Both groups followed the same postoperative multimodal analgesic protocol. The primary outcome was perioperative opioid requirements from the start of surgery until 48 hours postoperatively (expressed as IV milligram morphine equivalents [MME]). Secondary outcomes were Numerical Rating Scale (NRS) scores, start to sitting and ambulation, postoperative complications and length of hospital stay. Of 40 patients, 17 (42.5%) patients underwent ultrasound-guided TAP block (TAP group -control group-), while 23(57.5%) did not (non-TAP group). Perioperative opioid requirements were similar and extremely low (TAP and non-TAP group: median 0 (IQR:0-0) IV MME; P=0.962), as well as NRS scores (median ≤ 1) at 1, 2, 4, 6, 12, 18, 24 and 48 h (P>0.05). Multivariate analysis showed no independent association between perioperative IV MME and TAP block (median difference -0.1, 95% CI: -0.6 to 0.5, P=0.741). Start to sitting and ambulation, postoperative complications or length of hospital-stay did not show statistical differences. In our single-center study, when extraperitoneal RALP was performed, the TAP block under OFA strategy did not offer clinical analgesic benefit.

Recovery of urinary continence after robot-assisted laparoscopic radical prostatectomy: Comparison of two surgical techniques.

Automated electronic medical record abstraction algorithm for radical prostatectomy outcomes.

Operative time prediction is crucial for efficient operating room scheduling. This study developed and validated an operative time prediction system for robot-assisted laparoscopic radical prostatectomy using data from two institutions. Retrospectively identified 557 and 150 patients who underwent RARP at Tohoku University Hospital and Miyagi Cancer Center were analyzed. The following variables were collected as explanatory variables for the prediction system: Age, height, body mass index, comorbidities, performance status, prostate volume, tumor extent of local invasion, grade group, prostatitis, preoperative treatment, history of intraperitoneal surgery, lymphadenectomy, and nerve-sparing. In addition, the observed operative time was collected as a source variable for the objective variable. The observed operative time was calculated as the sum of components related to institutional, operator, and patient factors. Approximation curves were applied to the first two components, while a random forest-based machine learning model was applied to the latter, resulting in the development of an integrated prediction system. The normalized root mean square error between the observed and predicted operative times was 0.107 in internal validation and 0.148 in external validation, demonstrating greater reliability than the expected operative time by operators in advance. Factors that are known to impact operative time, such as lymphadenectomy, grade group, prostate volume, and body mass index, were identified as contributing variables. The system provides a reliable and robust prediction focusing on factors known to impact operative time. It has the potential to improve the efficiency of operating room scheduling.

Introduction: prostate cancer (PCa) is the most frequently diagnosed malignancy in men worldwide. Approximately 15 % of cases present as high or very high risk, for which the optimal surgical approach remains controversial. The pentafecta has been proposed as a key indicator of surgical success, integrating oncological and functional outcomes. This study aimed to compare 12-month pentafecta outcomes between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) in patients with high and very high-risk PCa. Material and methods: a retrospective observational study was conducted from 2021 to 2024, including 25 patients with localized high or very high-risk PCa who underwent ORP or LRP with extended pelvic lymphadenectomy. Clinical, pathological, and functional variables were analyzed. Comparisons were made using Chi-square, Student’s t-test, or Mann-Whitney U test, according to data distribution. A p-value &lt; 0.05 was considered statistically significant. Results: of the 25 patients, 12 underwent ORP and 13 underwent LRP. The overall pentafecta rate was 36 %. ORP showed a higher rate (50 %) compared to LRP (23 %) (p=0.061). ORP was associated with better biochemical control (p=0.023), fewer perioperative complications (p=0.054), and better erectile function outcomes (p=0.005). Urinary continence rates were similar between groups (p=0.317). Conclusions: we did not find statistically significant differences in the global pentafecta evaluation; however, the ORP showed important clinical differences in comparison to LRP.

To investigate the current evidence in post-operative outcomes to support the use of Robotic-Assisted Laparoscopic (radical) Prostatectomy (RALP) over Laparoscopic Radical Prostatectomy (LRP) in cases of organ-confined prostate cancer. A systematic review was performed according to PRISMA/MOOSE guidelines. Dichotomous variables were pooled as risk ratios (RR). Continuous variables were pooled as weighted mean differences (WMD). Quality assessment was performed using the Newcastle-Ottawa score (NOS). Four suitable randomised controlled studies were identified from the literature. 1026 male patients with prostate cancer (LRP n = 342, 33.33%; RALP n = 684, 66.67%) were identified as eligible for inclusion. These patients were randomised for definitive operative management to RALP or LRP. There was no statistically significant difference identified in operative time (MD -2.81, 95% CI -12.92-7.31, I2 = 77%, P = 0.59). There was no statistically significant difference identified in operative blood-loss (MD -9.34, 95% CI -55.81 + 37.12, I2 = 77%, P = 0.69). There was no statistically significant difference identified in biochemical recurrence free rates at 12 months. Statistically significant differences were identified in meta-analysis of post-operative urinary continence, and post-operative potency. These favoured RALP over LRP. No statistically significant difference was identified in operative time, operative blood-loss, or biochemical recurrence free rates at 12 months. There is an statistically significant improved post-operative profile of patients having undergone RALP v LRP, in particular with respect to return of sexual function and urinary continence. There was no statistical difference identified in intra-operative blood-loss, perioperative complications, or operative time.

BackgroundAccurate diagnosis and staging are essential for optimal treatment planning of prostate cancer. By combining functional and anatomical imaging, PSMA-PET/mpMRI offers a potential to improve lesion detection and enhance staging accuracy. This study aimed to evaluate the diagnostic performance of lesion detection and local staging of prostate cancer using combined PSMA-PET/mpMRI compared to standalone mpMRI or PSMA-PET.ResultsFifty-five patients with intermediate- to high-risk prostate cancer scheduled for robot-assisted laparoscopic radical prostatectomy were included. All patients underwent [68Ga]PSMA-PET/mpMRI prior to surgery. Whole-mount histopathology and surgical report served as reference standard. Two radiologists independently evaluated mpMRI, while two nuclear medicine physicians assessed PSMA-PET. For the PSMA-PET/mpMRI analysis, a consensus evaluation was performed by a new set of readers in two teams, each comprising one radiologist and one nuclear medicine physician. Lesion localization was reported based on the PI-RADS v2.1 sector map and compared to histopathology. Among 130 histopathologically confirmed lesions, mean detection rates were 38% (49.5/130) for PSMA-PET/mpMRI, 32% (41/130) for mpMRI and 32% (41/130) for PSMA-PET. For clinically significant prostate cancer (csPC) (≥0.5 ml, ≥ISUP 2; 42 lesions), mean detection rates were 85% (35.5/42) for PSMA-PET/mpMRI, 75% (31.5/42) for mpMRI and 70% (29.5/42) for PSMA-PET. The mean false discovery rates were 8% (PSMA-PET/mpMRI), 15% (mpMRI) and 12% (PSMA-PET). The likelihood of extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were scored using a 5-point Likert scale, where scores of 1–3 were classified as negative and scores of 4–5 were considered positive. Sensitivity for EPE was 32% for PSMA-PET/mpMRI, 37% for mpMRI and 7% for PSMA-PET, with a specificity of 100%, 96% and 98%, respectively. For SVI, sensitivity was 50% for PSMA-PET/mpMRI and 38% for mpMRI and PSMA-PET, with a specificity of 100%, 95% and 97% respectively.ConclusionsPSMA-PET/mpMRI provided higher and a more consistent performance in localized prostate cancer detection and staging without increasing false-positive findings.

Background/Objectives: Urinary incontinence (UI) remains a common and distressing complication following radical prostatectomy (RP). This prospective observational study aimed to assess the effectiveness of structured pelvic floor rehabilitation and to identify clinical and surgical predictors of continence recovery. Methods: A total of 182 patients undergoing RP received standardized physiotherapist-guided pelvic floor muscle training (PFMT), including supervised sessions before and after surgery, as well as individualized home exercise programs. UI severity was evaluated using a 1 h pad test and a four-level UI stage classification at three time points. The primary outcomes were changes in UI stage and the achievement of full continence, defined as a pad test result ≤2 g. Results: Following three rehabilitation sessions, 80.2% of patients regained full continence. Preoperative PFMT (β = −1.27, p = 0.0061) and shorter time to rehabilitation (β = −0.04, p = 0.0026) were associated with greater improvement in continence outcomes. Patients treated with robot-assisted RP showed a higher probability of continence recovery compared to those undergoing laparoscopic RP, particularly in the presence of moderate to severe baseline incontinence. Higher baseline urinary leakage significantly decreased the odds of treatment success (β = −0.01, p = 0.0001). ISUP grade and extraprostatic extension were not independently associated with outcomes. Conclusions: Despite the absence of a control group, this study demonstrates the effectiveness of structured and personalized pelvic floor rehabilitation in improving post-RP continence. Early initiation and preoperative training should be prioritized to optimize recovery in routine clinical practice.

Prognostic significance of the pan-immune-inflammation value for overactive bladder following laparoscopic radical prostatectomy in prostate cancer.

From learning curve to standardization: the evolution of 3D laparoscopic radical prostatectomy in a high-volume institution

Neo-adjuvant 177-Lutetium-PSMA radioligand therapy in patients with regional lymph-node metastatic prostate cancer undergoing robot-assisted laparoscopic radical prostatectomy and extended pelvic lymph node dissection. A phase 1 – 2 study

Purpose: To compare perioperative, functional, and oncologic outcomes of biopsy-free radical prostatectomy (BF-RP) vs conventional radical prostatectomy (C-RP) in patients with suspected prostate cancer. Materials and Methods: This retrospective study included patients undergoing radical prostatectomy at Tongji Hospital from January 2022 to December 2024. After 1:1 propensity score matching for preoperative PSA and pathological T stage, 108 BF-RP and 108 C-RP patients were analyzed. BF-RP was defined as prostatectomy without prior biopsy, based on mpMRI (PI-RADS ≥ 4) and multidisciplinary team consensus. Outcomes included urinary continence (≤1 pad/day), sexual function (IIEF-5 ≥ 17), perioperative metrics, complications, and biochemical recurrence within 1 year. Results: BF-RP patients had shorter hospital stays (median 5 vs 6 days, P &lt; .001) and earlier drain removal (4 vs 5 days, P = .0356). No significant differences were found in operative time, blood loss, transfusion, or positive margins (46.3% vs 51.9%, P = .4963). Complication rates were similar (11.1% vs 14.8%, P = .544). Urinary continence favored BF-RP at 2 weeks (35.2% vs 15.7%, P = .0011) and 3 months (83.3% vs 66.7%, P = .0042). While not reaching statistical significance, patients undergoing BF-RP demonstrated a favorable trend toward earlier recovery of sexual function and improved biochemical recurrence-free survival. Conclusions: In patients with prostate cancer, BF-RP demonstrates oncologic control and complication rates comparable with those of conventional surgery. It may also be associated with improved early recovery of sexual function and urinary continence, as well as shorter catheterization and hospital stays. These findings suggest the potential of BF-RP as an alternative approach for select patients; however, prospective studies are needed to further validate these results.

Smoking and Surgical Complications Following Robotic-Assisted Laparoscopic Radical Prostatectomy: A NSQIP Analysis.

This study aims to compare the perioperative outcomes, postoperative urinary control rates, and positive surgical margin (PSM) rates of robot-assisted laparoscopic radical prostatectomy using a combined anterior and posterior approach (AP-RARP) with those of the Retzius-sparing (RS-RARP) and standard anterior (anterior-RARP) approaches in prostate cancer treatment. We collected and analyzed medical data from prostate cancer patients who underwent one of these three approaches. No statistically significant differences were observed in operative time, intraoperative blood loss, transfusion rates, anastomotic leakage, or postoperative infection rates among the groups. PSM rates were comparable across the three groups in patients with T2 stage disease, whereas AP-RARP and anterior-RARP demonstrated lower PSM rates compared to RS-RARP in patients with T3a stage disease. The RS-RARP group demonstrated lower immediate and 1-month postoperative continence rates than the AP-RARP and anterior-RARP groups. At 3 months postoperatively, continence rates in both RS-RARP and AP-RARP groups were lower than those observed in the anterior-RARP group, with no significant differences among the groups at 6 months postoperatively. In conclusion, AP-RARP appears to be a viable surgical option for prostate cancer treatment.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-21851-4.