Abstract
OBJECTIVE: To assess the clinical application and efficacy of robotic radical prostatectomy in 50 cases of large-volume (> 100 ml) prostate cancer. METHOD: A retrospective analysis was conducted on 50 patients with large-volume (> 100 ml) prostate cancer who underwent robotic radical prostatectomy from June 2020 to August 2023. Patient ages ranged from 55 to 77 years (mean: 66.5 ± 10.5 years). Total PSA levels ranged from 7.9 to 98.5 ng/ml (mean: 18.7 ± 9.3 ng/ml), and the f/t PSA ratio ranged from 0.12 to 0.94 (mean: 0.35 ± 0.21). Gleason scores were: 15 scored 7, 24 scored 8, 10 scored 9, and 1 scored 10. Preoperative evaluations included lab tests, pelvic MRI, and whole-body bone scans. Patients without surgical contraindications underwent robotic radical prostatectomy. RESULTS: All surgeries were completed without conversion to open surgery or major vascular injuries. Operative time ranged from 80 to 150 min (mean: 105 min). Blood loss ranged from 30 to 450 ml (mean: 110 ml), with no transfusions required. Postoperative hospital stays ranged from 2 to 8 days (mean: 4.5 days). Catheter removal occurred between 3 and 7 days postoperatively (mean: 4 days). Time to first flatus ranged from 1 to 3 days (mean: 1.5 days). Two cases had postoperative lymphatic leakage. Pathology revealed positive surgical margins in 3 cases, with stage distribution of 22 in T2a, 15 in T2b, 7 in T3a, and 6 in T3b; 2 cases had positive lymph nodes. Follow-up ranged from 2 to 26 months (median: 12.5 months). The one-year biochemical recurrence rate was 7.9% (3/38), and the one-year urinary continence satisfaction rate was 92.1% (35/38). CONCLUSION: Robotic radical prostatectomy for large-volume prostate cancer, despite its surgical challenges, is a safe and feasible approach. With sufficient surgical experience and case volume, satisfactory outcomes can be achieved.