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Cancers
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The Role of Robot‐Assisted Radical Prostatectomy in Prostate Cancer
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The Role of Robot‐Assisted Radical Prostatectomy in Prostate Cancer

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

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 2450

Special Issue Editors

Dr. Katharina Boehm

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Guest Editor
Department of Urology, Carl-Gustav-Carus University Hospital of the Technical University, Dresden, Germany
Interests: urologic oncology; robotic surgery; public healthcare
Dr. Marianne Leitsmann

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Guest Editor
Department of Urology, LKH-Univ. Klinikum Graz, Medical University Graz (MUG), Graz, Austria
Interests: robotic surgery; prostate cancer; urothelial cancer; augmented reality
Dr. Peter Sparwasser

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Guest Editor
Department of Urology, University Hospital and Faculty of Medicine Eberhard Karls, University Tübingen, Tübingen, Germany
Interests: robotic surgery; prostate cancer; urothelial cancer; augmented reality

Special Issue Information

Dear Colleagues,

Robot-assisted radical prostatectomy has become the gold standard for the surgical treatment of prostate cancer.

In recent years, new players in terms of surgical techniques are gaining importance, and additional techniques for cancer visualization have been introduced.

In this Special Issue, we want to discuss benefits and drawbacks, as well as new developments, associated with robotic surgery for prostate cancer. We want to discuss the implementation of AI, as well as 3D modelling, cancer visualization and associated topics. Additionally, we are interested in public healthcare data concerning robot-assisted radical prostatectomy and patient-related outcomes.

The aim of this Special Issue is to provide an overview of the current status of robotic surgery, as well as its future goals and unmet needs.

Dr. Katharina Boehm
Dr. Marianne Leitsmann
Dr. Peter Sparwasser
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

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
  • robotic surgery
  • radical prostatectomy
  • artificial intelligence
  • imaging

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Published Papers (3 papers)

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Research

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11 pages, 471 KiB  
Article
Extended Lymph Node Dissection May Not Provide a Therapeutic Benefit in Patients with Intermediate-to High-Risk Prostate Cancer Treated with Robotic-Assisted Radical Prostatectomy
by Noriyoshi Miura, Masaki Shimbo, Dai Okawa, Miki Sakamoto, Naoya Sugihara, Takatora Sawada, Shunsuke Haga, Haruna Arai, Keigo Nishida, Osuke Arai, Tomoya Onishi, Ryuta Watanabe, Kenichi Nishimura, Tetsuya Fukumoto, Yuki Miyauchi, Tadahiko Kikugawa, Takato Nishino, Fumiyasu Endo, Kazunori Hattori and Takashi Saika
Cancers 2025, 17(4), 655; https://doi.org/10.3390/cancers17040655 - 14 Feb 2025
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Abstract
Background: The therapeutic efficacy of extended lymph node dissection (ePLND) for intermediate- and high-risk (IR/HR) prostate cancer remains controversial. This study evaluated whether PLND improved biochemical recurrence (BCR) rates in patients with prostate cancer undergoing robotic-assisted radical prostatectomy (RARP) using a propensity matching [...] Read more.
Background: The therapeutic efficacy of extended lymph node dissection (ePLND) for intermediate- and high-risk (IR/HR) prostate cancer remains controversial. This study evaluated whether PLND improved biochemical recurrence (BCR) rates in patients with prostate cancer undergoing robotic-assisted radical prostatectomy (RARP) using a propensity matching method with cases from two facilities. Methods: The study included 1002 patients with IR/HR disease who underwent RARP at two facilities with equivalent surgical techniques and hospital size but different ePLND policies for IR/HR between July 2012 and November 2022. We compared perioperative outcomes, complications, and biochemical recurrence-free survival (bRFS) between the centers. Results: After propensity matching, 221 and 124 cases, each at intermediate and high risk, respectively, were compared. Except for age, preoperative clinicopathological variables did not differ significantly between the matched ePLND and non-PLND groups. A median of 18 lymph nodes were assessed in the dissection group. The 3-year bRFS rates did not differ significantly between ePLND and non-PLND among intermediate-risk and high-risk patients. The dissection group had significantly longer operative times and more complications associated with ePLND, including lower extremity edema, pelvic hematoma, and neuropathy. A multivariable Cox regression analysis performed after propensity adjustment identified initial prostate-specific antigens, pathological tumor stage (high-risk only), and positive surgical margins as independent prognostic factors for bRFS while ePLND was not significant. Conclusions: These results suggest that ePLND may not be necessary in intermediate- to high-risk PCa patients undergoing RARP, although further study with a longer follow-up is required. Full article
(This article belongs to the Special Issue The Role of Robot‐Assisted Radical Prostatectomy in Prostate Cancer)
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13 pages, 443 KiB  
Article
Patient-Reported Outcome Measures and Decision Regret After Salvage Radical Prostatectomy for Recurrent Prostate Cancer Following Radiotherapy or Focal Therapy
by Fabian Falkenbach, Johanna Hagemann, Francesca Ambrosini, Pierre I. Karakiewicz, Zhe Tian, Yamini Nagaraj, Burkhard Beyer, Philipp Mandel, Felix Preisser, Derya Tilki, Tobias Maurer, Lars Budäus, Hans Heinzer, Alexander Haese, Thomas Steuber, Georg Salomon and Markus Graefen
Cancers 2025, 17(3), 396; https://doi.org/10.3390/cancers17030396 - 25 Jan 2025
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Abstract
Background/Objectives: Radical prostatectomy (RP) may be considered for recurrent prostate cancer (PCa) following primary curative-intended local therapy. The effect of different prior therapies on patient-reported outcome measures (PROMs) after RP is not well defined. Methods: Validated PROMs (SF-12, EPIC-26, Decision Regret Scale) were [...] Read more.
Background/Objectives: Radical prostatectomy (RP) may be considered for recurrent prostate cancer (PCa) following primary curative-intended local therapy. The effect of different prior therapies on patient-reported outcome measures (PROMs) after RP is not well defined. Methods: Validated PROMs (SF-12, EPIC-26, Decision Regret Scale) were used to compare health-related quality of life (HRQOL) and functional status changes following salvage RP after radiotherapy (RT-sRP) or focal therapy (FT-sRP), relative to primary RP. Results: Among 26,515 RP patients who underwent RP between 2014 and 2024, 107 (0.4%) previously received radiotherapy (RT-sRP) and 98 (0.4%) previously received focal therapy (FT-sRP). Compared with primary patients before RP, only the sexual function of RT-sRP patients was lower (EPIC score, 51 vs. 75, p < 0.001). One year after RP, RT-sRP patients exhibited lower functional status in all EPIC-26 domains compared to primary RP patients, whereas FT-sRP patients did not differ significantly. For instance, the median 1 yr EPIC-26 urinary incontinence scores were 46 (RT-sRP), 86 (FT-sRP), and 92 (primary RP). In adjusted mixed model analyses, the detrimental effects of RT-sRP vs. primary RP were further validated. In contrast, no such association was observed for FT-sRP. Decision regret and severe complications were low. Conclusions: Prior FT had only a marginal effect on HRQOL and functional status following RP, while urinary continence and sexual function were lower for RT-sRP patients as compared to primary RP patients. However, from an overall PROM perspective, prior therapies did not exert a prohibitive effect that would preclude RP as a treatment option in those patients. Full article
(This article belongs to the Special Issue The Role of Robot‐Assisted Radical Prostatectomy in Prostate Cancer)
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Review

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16 pages, 265 KiB  
Review
The Role of Robot-Assisted, Imaging-Guided Surgery in Prostate Cancer Patients
by Leonardo Quarta, Donato Cannoletta, Francesco Pellegrino, Francesco Barletta, Simone Scuderi, Elio Mazzone, Armando Stabile, Francesco Montorsi, Giorgio Gandaglia and Alberto Briganti
Cancers 2025, 17(9), 1401; https://doi.org/10.3390/cancers17091401 - 23 Apr 2025
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Abstract
Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons’ ability to remove all cancer sites and thus patients’ outcomes. Sentinel node [...] Read more.
Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons’ ability to remove all cancer sites and thus patients’ outcomes. Sentinel node biopsy (SNB) represents an imaging-guided technique that could enhance nodal staging accuracy by leveraging lymphatic mapping with tracers. PSMA-RGS uses radiolabeled tracers with the aim to improve intraoperative lymph node metastases (LNMs) detection. Several studies demonstrated its feasibility and safety, with promising accuracy in nodal staging during robot-assisted radical prostatectomy (RARP) and in recurrence setting during salvage lymph node dissection (sLND) in patients who experience biochemical recurrence (BCR) after primary treatment and have positive PSMA positron emission tomography (PET). Near-infrared PSMA tracers, such as OTL78 and IS-002, have shown potential in intraoperative fluorescence-guided surgery, improving positive surgical margins (PSMs) and LNMs identification. Finally, augmented reality (AR), which integrates preoperative imaging (e.g., multiparametric magnetic resonance imaging [mpMRI] of the prostate and computed tomography [CT]) onto the surgical field, can provide a real-time visualization of anatomical structures through the creation of three-dimensional (3D) models. These technologies may assist surgeons during intraoperative procedures, thus optimizing the balance between oncological control and functional outcomes. However, challenges remain in standardizing these tools and assessing their impact on long-term PCa control. Overall, these advancements represent a paradigm shift toward personalized and precise surgical approaches, emphasizing the integration of innovative strategies to improve outcomes of PCa patients. Full article
(This article belongs to the Special Issue The Role of Robot‐Assisted Radical Prostatectomy in Prostate Cancer)
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