To Medical Oncologists: Can We Safely Trust and Recommend the Robot Assisted Radical Prostatectomy?

Abstract

Widespread screening using serum prostate specific antigen (PSA) and digital rectal exam (DRE) resulted in an increased incidence of early diagnosis of prostate cancer. The surgery remains the mainstay treatment of early localized prostate adenocarcinoma, especially in young population. Radical prostatectomy can be performed via an open surgery requiring a large vertical incision or via a minimally invasive technique consisting of laparoscopic radical prostatectomy (LRP) or robot assisted radical prostatectomy (RARP). The main risks and complications of any radical surgical procedure are the bleeding and infectious risks, the post-operative recovery (pain, hospital stay) and most importantly the oncologic outcomes (to have negative margins and complete radical excision of the tumor, to avoid recurrence, to improve survival). Besides, radical prostatectomy has other specific complications related to the anatomic localization of the prostate gland: erectile dysfunction, urinary incontinence, urethral strictures and impotence. Thus, the least debilitating surgical procedure associated with an excellent oncologic control without affecting the quality of life remained a challenge for many years especially that the results of the minimally invasive LRP weren’t so promising at the beginning.