https://doi.org/10.4081/aiua.2026.15886
Early functional and oncological outcomes after robot-assisted radical prostatectomy in D’Amico high-risk prostate cancer: a prospective cohort study
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Accepted: 26 August 2026
Published: 25 September 2026
Background: Robot-assisted radical prostatectomy (RARP) is an established treatment option for D’Amico high-risk prostate cancer within multimodal therapy concepts. While oncological outcomes are well documented, data on very early functional recovery remain limited. This prospective study evaluated early continence outcomes and biochemical recurrence (BCR)-free survival after RARP in D’Amico high-risk patients.
Methods: Clinical, pathological, functional, and follow-up data from patients undergoing RARP between February 2021 and May 2024 were prospectively collected. Among 361 consecutive patients, 109 met D’Amico high-risk criteria and were included. Pre-operative variables included prostate-specific antigen (PSA), prostate volume, biopsy Gleason grade group, and clinical stage. Pathological outcomes comprised tumor stage, surgical margin status, lymph node involvement, and post-operative PSA nadir. Early continence was assessed using a standardized post-operative pad test and BCR-free survival was analyzed using Kaplan- Meier analysis.
Results: Median pre-operative PSA was 9.8 ng/mL, and most patients had biopsy Gleason grade group ≥ 3. Locally advanced disease predominated, with pT3a and pT3b tumors in 56.9% and 32.1% of patients, respectively. Positive surgical margins occurred in 36.7% of cases, while 61.5% achieved a PSA nadir of 0.01 ng/mL. After a median follow-up of 30.8 months, BCR occurred in 22.9% of patients. Serious peri-operative complications (Clavien-Dindo ≥ III) were rare (2.8%). Gleason score and tumor stage were significantly associated with BCR, and early pad test results strongly predicted continence at one year.
Conclusions: RARP provided acceptable early continence recovery and meaningful oncological control in D’Amico high-risk prostate cancer, supporting its role within multimodal treatment strategies.
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1. Johns LE, Houlston RS. A systematic review and meta-analysis of familial prostate cancer risk. BJU Int 2003; 91:789-94. DOI: https://doi.org/10.1046/j.1464-410X.2003.04232.x
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49. DOI: https://doi.org/10.3322/caac.21660
3. D'Amico AV, Whittington R, Malkowicz SB, et al. Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998; 280:969-74. DOI: https://doi.org/10.1001/jama.280.11.969
4. Stewart SB, Boorjian SA. Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective. Urol Oncol 2015; 33:235-44. DOI: https://doi.org/10.1016/j.urolonc.2014.10.003
5. Mottet N, van den Bergh RCN, Briers E, et al. EAU-EANMESTRO- ESUR-SIOG guidelines on prostate cancer – 2020 update. Part 1: Screening, diagnosis, and local treatment with curative intent. Eur Urol 2021; 79:243-62. DOI: https://doi.org/10.1016/j.eururo.2020.09.042
6. Liu S, Hemal A. Techniques of robotic radical prostatectomy for the management of prostate cancer: which one, when and why. Transl Androl Urol 2020; 9:906-18. DOI: https://doi.org/10.21037/tau.2019.09.13
7. Lantz A, Bock D, Akre O, et al. Functional and oncological outcomes after open versus robot-assisted laparoscopic radical prostatectomy for localised prostate cancer: 8-year follow-up. Eur Urol 2021;80:650-60. DOI: https://doi.org/10.1016/j.eururo.2021.07.025
8. Greenberger BA, Zaorsky NG, Den RB. Comparison of radical prostatectomy versus radiation and androgen deprivation therapy strategies as primary treatment for high-risk localized prostate cancer: a systematic review and meta-analysis. Eur Urol Focus 2020; 6:404-18. DOI: https://doi.org/10.1016/j.euf.2019.11.007
9. Wang Z, Zhang Y, Wang X, et al. The efficacy and safety of radical prostatectomy and radiotherapy in high-risk prostate cancer: a systematic review and meta-analysis. World J Surg Oncol 2020;18:42. DOI: https://doi.org/10.1186/s12957-020-01824-9
10. Wu X, Wong CHM, Gandaglia G, Chiu PKF. Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy. Curr Opin Urol 2023; 33:482-7. DOI: https://doi.org/10.1097/MOU.0000000000001127
11. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205-13. DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae
12. Falagario UG, Martini A, Wenzel M, et al. Biochemical recurrence and risk of mortality following radiotherapy or radical prostatectomy. JAMA Netw Open 2023; 6:e2332900. DOI: https://doi.org/10.1001/jamanetworkopen.2023.32900
13. Tilki D, Preisser F, Tennstedt P, et al. Prostate-specific antigen level at the time of salvage therapy after radical prostatectomy for prostate cancer and the risk of death. J Clin Oncol 2023; 41:2428-35. DOI: https://doi.org/10.1200/JCO.22.02489
14. Spratt DE, McHugh DJ, Morris MJ, Morgans AK. Management of biochemically recurrent prostate cancer: ensuring the right treatment of the right patient at the right time. Am Soc Clin Oncol Educ Book 2018; 38:355-62. DOI: https://doi.org/10.1200/EDBK_200319
15. Preisser F, Tilki D, Bandini M, et al. European Association of Urology biochemical recurrence risk classification as a decision tool for salvage radiotherapy: a multicenter study. Eur Urol 2024;85:164-70. DOI: https://doi.org/10.1016/j.eururo.2023.05.038
16. Hamdy FC, Donovan JL, Lane JA, et al. Fifteen-year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med 2023; 388:1547-58. DOI: https://doi.org/10.1056/NEJMoa2214122
17. Lysenko I, Kattan MW, Vickers AJ, et al. Prognostic value of Gleason score at positive surgical margin in prostate cancer: a systematic review and meta-analysis. Clin Genitourin Cancer 2020;18:e517-22. DOI: https://doi.org/10.1016/j.clgc.2020.02.011
18. Marcq G, Rozet F, Beauval JB, et al. Risk of biochemical recurrence based on extent and location of positive surgical margins after robot-assisted laparoscopic radical prostatectomy. BMC Cancer 2018; 18:1291. DOI: https://doi.org/10.1186/s12885-018-5229-1
19. Hagman A, Stranne J, Carlsson S, et al. Positive surgical margin and oncological outcomes after robot-assisted radical prostatectomy in different Cancer of the Prostate Risk Assessment risk groups. BJU Int 2025; 136:135-42. DOI: https://doi.org/10.1111/bju.16732
20. Albertsen PC, Nease RF Jr, Potosky AL. Assessment of patient preferences among men with prostate cancer. J Urol 1998; 159:158-63. DOI: https://doi.org/10.1016/S0022-5347(01)64043-6
21. Haga N, Horie S, Yamaguchi A, et al. Comprehensive approach for post-prostatectomy incontinence in the era of robot-assisted radical prostatectomy. Fukushima J Med Sci 2017; 63:46-56. DOI: https://doi.org/10.5387/fms.2017-15
22. Chen WH, Lee YK, Kuo HC, et al. Oncological and functional outcomes of high-risk and very high-risk prostate cancer patients after robot-assisted radical prostatectomy. PLoS One 2023; 18:e0282494. DOI: https://doi.org/10.1371/journal.pone.0282494
23. Tienza A, Akin Y, Rassweiler J, Gözen AS. A match-pair analysis of continence in intermediate and high-risk prostate cancer patients after robot-assisted radical prostatectomy: the role of urine loss ratio and predictive analysis. Prostate Int 2018; 6:94-8. DOI: https://doi.org/10.1016/j.prnil.2017.09.001
24. Murphy DG, Kerger M, Crowe H, et al. Operative details and oncological and functional outcome of robotic-assisted laparoscopic radical prostatectomy: 400 cases with a minimum of 12 months follow-up. Eur Urol 2009; 55:1358-67. DOI: https://doi.org/10.1016/j.eururo.2008.12.035
25. Greco KA, Meeks JJ, Wu S, Nadler RB. Robot-assisted radical prostatectomy in men aged ≥70 years. BJU Int 2009; 104:1492-5. DOI: https://doi.org/10.1111/j.1464-410X.2009.08718.x
26. Wille S, Heidenreich A, von Knobloch R, et al. Impact of comorbidities on post-prostatectomy incontinence. Urol Int 2006; 76:223-6. DOI: https://doi.org/10.1159/000091623
27. Wang J, Liu X, Wang Z, et al. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 2023; 17:2617-31. DOI: https://doi.org/10.1007/s11701-023-01714-8
28. Qin Y, Li P, Wang Z, et al. Comparison and trend of perioperative outcomes between robot-assisted radical prostatectomy and open radical prostatectomy: nationwide inpatient sample 2009-2014. Int Braz J Urol 2020; 46:754-71. DOI: https://doi.org/10.1590/s1677-5538.ibju.2019.0420
CRediT authorship contribution
Jonathan Michel Keller - Writing - original draft, Data curation; Mladen Stankovic - Project administration, Conceptualization, Formal analysis, Investigation, Methodology, Visualization, Writing - review and editing; Teresa Wieder - Data curation, Investigation; Laura Wolff - Data curation, Investigation; Joao Mendes - Data curation, Investigation.
Supporting Agencies
Data Availability Statement
The datasets used and/ or analyzed during the current study are available upon reasonable request from the corresponding author.
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