Robot-Assisted versus Open Radical Prostatectomy in the Treatment of Localized Prostate Cancer: 3-Year Results from a Prospective Cohort Study.

Purpose: Radical prostatectomy remains the primary treatment for localized prostate cancer (PCa). Despite its use for over two decades, the benefits of robot-assisted radical prostatectomy (RARP) remain unclear. We evaluated the surgical, functional, and oncological outcomes between RARP and open radical retropubic prostatectomy (RRP).

Materials and methods: This prospective cohort study included men who underwent radical prostatectomy between March 2016 and April 2020. We excluded patients who received preoperative androgen-deprivation therapy, had an initial prostate-specific antigen level of >50 ng/mL, had a clinical T stage of ≥T3b, and those aged under 50 or over 80 years. The primary outcome was the 90-day complication rate. Surgical and oncologic outcomes were compared. Continence and potency recovery were depicted using Kaplan-Meier curves and assessed using the log-rank test. To balance baseline characteristics, stabilized inverse probability of treatment weighting (sIPTW) was used.

Results: Among the 1,306 patients assessed, 1,055 were included after exclusion and adjustment using the sIPTW (RARP, n=835; RRP, n=220), with a median follow-up of 39 months. The RARP group had a significantly lower 90-day complication rate than the RRP group (8.9% vs. 26.4%; p<0.001). The RARP group showed significantly better surgical outcomes, including estimated blood loss and surgical margins. At 36 months, the pad-free rates were 86.1% and 88.4% for the RARP and RRP groups, respectively (log-rank test, p=0.642). Potency recovery was superior in the RARP group (11.4% vs. 5.2%; log-rank test, p=0.001). Biochemical recurrence (RARP, 23.7%; RRP, 27.9%; p=0.246) and rates of additional treatment (RARP, 23.5%; RRP, 28.1%; p=0.202) were not different. Single-institution study is a potential limitation.

Conclusions: The findings indicate that RARP is associated with a better safety profile and surgical outcomes without compromising short-term oncologic outcomes than RRP. While continence recovery was comparable between the methods, RARP may offer superior potency recovery.