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 238

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Centrum Medyczne Kształcenia Podyplomowego, Warsaw, Poland
Interests: urologic oncology; endoscopic surgery; molecular diagnostics
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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

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Keywords

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

Published Papers (1 paper)

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Research

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 124
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
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