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Robot-Assisted Radical Prostatectomy for Urologic Cancer: State of the Art
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Robot-Assisted Radical Prostatectomy for Urologic Cancer: State of the Art

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 20 December 2024 | Viewed by 2894

Special Issue Editor

Prof. Dr. Jakub Dobruch

E-Mail Website
Guest Editor
Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland
Interests: urologic oncology; endoscopic surgery; molecular diagnostics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Prostate cancer (PCa) is the second most common malignancy diagnosed in men worldwide and radical prostatectomy (RP) remains the mainstay therapy for organ-confined disease. The technological revolution, along with sophisticated improvements in surgical techniques, has led to the predominance of robotic surgery over previous RP approaches. Currently, in most advanced health systems, robot-assisted radical prostatectomy (RALP) is the most prevalent surgical approach in PCa therapy.

Numerous robotic platforms have been recently introduced and their urological applications have been consistently studied, including RALP (SP daVinci, Kang Duo, Hugo, and Dexter, to list a few). Surgery has become less invasive and better studied, with shorter learning curves in tertiary, high-volume centers, where RALP has resulted in lower rates of positive surgical margins, with lower morbidity. Combined with modern imaging (multiparametric MRI, PET/PSMA) and molecular markers, the treatment landscape of PCa is changing. RALP has become more individualized and is tailored to patient needs and expectations. Neoadjuvant and adjuvant therapies will further shape PCa surgical management.    

Despite all the efforts and obvious progress, a third of patients subjected to RALP develop biochemical failure. Understanding the best candidates for surgery, in whom it could, and should, be omitted due to a low risk of cancer progression or unacceptable risk of morbidity, and in whom it should be preceded with neoadjuvant therapy or supplemented with radiation or systemic management remain still to be seen. This Special Issue will highlight the role of robot-assisted surgery in the current and future landscape of prostate cancer therapy. A number of clinical applications and their utility will be presented and discussed.

Prof. Dr. Jakub Dobruch
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prostate cancer
  • bladder cancer
  • upper urinary tract tumors
  • kidney cancer
  • testicular tumors
  • molecular markers
  • lymph node metastasis
  • diagnosis
  • radical treatment
  • systemic treatment

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Published Papers (3 papers)

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Research

11 pages, 861 KiB  
Article
The Association Between Lymphovascular or Perineural Invasion in Radical Prostatectomy Specimen and Biochemical Recurrence
by Carolin Siech, Mike Wenzel, Nico Grosshans, Cristina Cano Garcia, Clara Humke, Florestan Johannes Koll, Zhe Tian, Pierre I. Karakiewicz, Luis A. Kluth, Felix K. H. Chun, Benedikt Hoeh and Philipp Mandel
Cancers 2024, 16(21), 3648; https://doi.org/10.3390/cancers16213648 - 29 Oct 2024
Viewed by 523
Abstract
Objective: The aim of this study was to test for the association between lymphovascular invasion or perineural invasion in radical prostatectomy (RP) specimens and biochemical recurrence (BCR). Methods: Relying on a tertiary-care database, we identified prostate cancer patients treated with RP between January [...] Read more.
Objective: The aim of this study was to test for the association between lymphovascular invasion or perineural invasion in radical prostatectomy (RP) specimens and biochemical recurrence (BCR). Methods: Relying on a tertiary-care database, we identified prostate cancer patients treated with RP between January 2014 and June 2023. Of these, the majority underwent robotic-assisted RP (81%). Kaplan–Meier survival analyses and Cox regression models addressed BCR according to either lymphovascular invasion or perineural invasion in RP specimens. Additionally, the linear trend test assessed the association between the Gleason Grade Group or pathologic tumor stage and lymphovascular or perineural invasion. Results: Of 822 patients, 78 (9%) exhibited lymphovascular invasion and 633 (77%) exhibited perineural invasion in RP specimens. In survival analyses, the five-year BCR-free survival rates were 62% in patients with lymphovascular invasion vs. 70% in patients without lymphovascular invasion (p = 0.04) and 64% in patients with perineural invasion vs. 82% in patients without perineural invasion (p = 0.01). In univariable Cox regression models, lymphovascular invasion (hazard ratio 1.58, 95% confidence interval 1.01–2.47; p = 0.045) and perineural invasion (hazard ratio 1.77, 95% confidence interval 1.13–2.77; p = 0.013) were both associated with a higher BCR rate. After accounting for age at surgery, PSA value, pathologic tumor stage, Gleason Grade Group, lymph node invasion, positive surgical margin, surgical approach, and adjuvant radiation therapy, lymphovascular (p = 0.740) or perineural invasion (p = 0.341) were not significantly associated with a higher BCR since the Gleason Grade Group and pathologic tumor stage highly correlated with lymphovascular as well as perineural invasion. Conclusions: In univariable models, lymphovascular or perineural invasion is associated with BCR. After adjustment for standard pathologic tumor characteristics, lymphovascular or perineural invasion is not an independent predictor for BCR. Full article
(This article belongs to the Special Issue Robot-Assisted Radical Prostatectomy for Urologic Cancer: State of the Art)
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11 pages, 1017 KiB  
Article
Single-Port Extraperitoneal vs. Multiport Transperitoneal Robot-Assisted Radical Prostatectomy: A Propensity Score-Matched Analysis
by Jaya S. Chavali, Adriana M. Pedraza, Nicolas A. Soputro, Roxana Ramos-Carpinteyro, Carter D. Mikesell and Jihad Kaouk
Cancers 2024, 16(17), 2994; https://doi.org/10.3390/cancers16172994 - 28 Aug 2024
Viewed by 1099
Abstract
(1) Background: Since the introduction of the purpose-built Single Port (SP) robotic platform, there has been an ongoing debate regarding its advantages compared to the established multi-port (MP) system. The goal of this present study is to compare the perioperative, oncological, and functional [...] Read more.
(1) Background: Since the introduction of the purpose-built Single Port (SP) robotic platform, there has been an ongoing debate regarding its advantages compared to the established multi-port (MP) system. The goal of this present study is to compare the perioperative, oncological, and functional outcomes of SP Extraperitoneal robotic radical prostatectomy (RARP) versus that of MP Transperitoneal RARP approach at a high-volume tertiary center. (2) Methods: Based on a retrospective review of the prospectively maintained IRB-approved database, 925 patients successfully underwent RARP by a single experienced robotic surgeon. A 4:1 propensity-matched analysis based on the baseline prostate cancer International Society of Urological Pathology (ISUP) Grade Group, clinical stage, and preoperative Prostate Specific Antigen (PSA) was performed, which yielded a cohort of 606 patients—485 in the SP EP and 121 in the MP TP approaches. Of note, the SP EP approach also included the traditional Extraperitoneal (n = 259, 53.4%) and the novel Transvesical (TV) approaches (n = 226, 46.6%). (3) Results: The overall operative time was slightly longer in the SP cohort, with a mean of 198.9 min compared to 181.5 min for the MP group (p < 0.001). There were no intraoperative complications with the MP approach and only one during the SP approach. The SP EP technique demonstrated significant benefits, encompassing reduced intraoperative blood loss (SP 125.1 vs. MP 215.9 mL), shorter length of hospital stay (SP 12.6 vs. MP 31.9 h), reduced opioid use at the time of discharge (SP 14.4% vs. MP 85.1%), and an earlier Foley catheter removal (SP 6 vs. MP 8 days). From an oncological perspective, the rate of positive surgical margins remained comparable across both groups (p = 0.84). Regarding functional outcomes, the mean continence rates and Sexual Health Inventory for Men (SHIM) scores were identical between the two groups at 6 weeks, 3 months, and 6 months respectively. (4) Conclusion: SP EP RARP demonstrates similar performance to MP TP RARP in terms of oncologic and functional outcomes. However, SP EP RARP offers several advantages in reducing the overall hospital stay, decreasing postoperative pain and hence the overall opioid use, as well as shortening the time to catheter removal, all of which translates to reduced morbidity and facilitates the transition to outpatient surgery. Full article
(This article belongs to the Special Issue Robot-Assisted Radical Prostatectomy for Urologic Cancer: State of the Art)
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14 pages, 1473 KiB  
Article
Prognostic Impact and Clinical Implications of Adverse Tumor Grade in Very Favorable Low- and Intermediate-Risk Prostate Cancer Patients Treated with Robot-Assisted Radical Prostatectomy: Experience of a Single Tertiary Referral Center
by Antonio Benito Porcaro, Alberto Bianchi, Sebastian Gallina, Andrea Panunzio, Alessandro Tafuri, Emanuele Serafin, Rossella Orlando, Giovanni Mazzucato, Paola Irene Ornaghi, Francesco Cianflone, Francesca Montanaro, Francesco Artoni, Alberto Baielli, Francesco Ditonno, Filippo Migliorini, Matteo Brunelli, Salvatore Siracusano, Maria Angela Cerruto and Alessandro Antonelli
Cancers 2024, 16(11), 2137; https://doi.org/10.3390/cancers16112137 - 4 Jun 2024
Viewed by 910
Abstract
Objectives: To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained [...] Read more.
Objectives: To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained institutional database. Adverse tumor grade was defined as pathology ISUP grade group > 2. Disease progression was defined as a biochemical recurrence event and/or local recurrence and/or distant metastases. Associations were assessed by Cox’s proportional hazards and logistic regression model. Results: Between January 2013 and October 2020, the study evaluated a population of 289 patients, including 178 low-risk cases (61.1%) and 111 intermediate-risk subjects (38.4%); unfavorable tumor grade was detected in 82 cases (28.4%). PCa progression, which occurred in 29 patients (10%), was independently predicted by adverse tumor grade and biopsy ISUP grade group 2, with the former showing stronger associations (hazard ratio, HR = 4.478; 95% CI: 1.840–10.895; p = 0.001) than the latter (HR = 2.336; 95% CI: 1.057–5.164; p = 0.036). Older age and biopsy ISUP grade group 2 were independent clinical predictors of adverse tumor grade, associated with larger tumors that eventually presented non-organ-confined disease. Conclusions: In a very favorable PCa patient population, adverse tumor grade was an unfavorable prognostic factor for disease progression. Active surveillance in very favorable intermediate-risk patients is still a hazard, so molecular and genetic testing of biopsy specimens is needed. Full article
(This article belongs to the Special Issue Robot-Assisted Radical Prostatectomy for Urologic Cancer: State of the Art)
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