Anterior vs. posterior robot-assisted radical prostatectomy: Insights from 10 years follow-up of a randomized controlled trial

Document Type

Conference Proceeding

Publication Date

3-1-2026

Publication Title

Eur Urol

Keywords

Urology & Nephrology

Abstract

Introduction & Objectives: In the evolving field of minimally invasive prostate surgery, the Retzius-sparing robot-assisted laparoscopic prostatectomy (RS or Posterior RALP), first described in 2010, was proposed to enhance early postoperative continence recovery, albeit at the cost of increased technical complexity. However, long-term oncological outcomes following this approach remain insufficiently characterized. The present study reports the 10-year oncological outcomes of a randomized controlled trial originally designed to compare early continence achievement between posterior and anterior approach. Materials & Methods: Men with low to intermediate-risk prostate cancer, underwent RALP at a tertiary referral center. Patients were randomized in a 1:1 ratio to receive either the anterior or the posterior approach (n = 60 per arm). The primary endpoint was event-free survival (EFS). Event was defined as occurrence of Biochemical Recurrence and/or any additional treatment. Kaplan-Meier plots were used to depict EFS and to compare it between the two approaches. Cox regression examined the impact of the approach on EFS, after adjusting for CAPRA-S classification. Results: Among the 120 randomized patients, the median age at surgery was 61 years (IQR 56–66), and the median PSA level was 5.70 ng/mL (IQR 4.73–7.35). Before surgery, 77% of the cohort met NCCN criteria for intermediate-risk disease. Final pathology showed ISUP ≥ 4 in 6.7% of in the anterior approach group and in 3.3% patients in the posterior group while pathological T3 stage was more frequently in the posterior (10%) rather than anterior (5%) group. Positive surgical margins were observed in 13% of anterior cases vs. 23% of the posterior cases. Median (IQR) follow-up was 77 months (30-110). A total of 20 Events occurred during the study period. At 10-years, EFS was 82% in anterior vs 50.5% in posterior group with a p value of 0.01. After adjusting for CAPRA-S classification patients undergoing posterior RALP were highly more likely to experience an event (HR 2.64, 95CI 1.00-6.99, p value= 0.04) Conclusions: Although RS-RALP provides superior early continence outcomes, it appears to be associated with less favorable long-term oncological control, potentially due to the increased technical demands of the procedure. These findings should be carefully considered when selecting the optimal surgical approach for each patient.

Volume

89

First Page

1

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