Robotic-assisted radical prostatectomy for large-volume prostates (>100 mL): perioperative, functional, and oncologic outcomes from a 5-year multicenter cohort.

Authors

Ahmed Rabie, Moustafa Elsawy, Zachary Dovey, Cristina Falavolti, Rocco Papalia, Stefano Signore, Alberto Martini, Massimiliano Di Marco, Mohammad Jaabou, Modassar Awan, Brooke Hildebrand, Tommasangelo Petitti, Maurizio Buscarini, Osama Zaytoun

Published in

Journal of robotic surgery. Volume 20. Issue 1. Jul 20, 2026. Epub Jul 20, 2026.

Abstract

Large prostate volume (> 100 mL) remains a technical challenge during robot-assisted radical prostatectomy (RARP), with limited long-term outcome data available in contemporary series. To evaluate perioperative, functional, and oncologic outcomes following RARP in patients with large-volume prostate cancer. A retrospective multicenter cohort study was performed including 201 consecutive patients with prostate volume > 100 mL who underwent RARP between January 2017 and December 2021, with follow-up extending through December 2023. The primary endpoint was biochemical recurrence-free survival (BCRFS). Secondary endpoints included overall survival (OS), cancer-specific survival (CSS), perioperative outcomes, urinary continence recovery, and erectile function recovery. Kaplan-Meier analyses, multivariable Cox proportional hazards regression, and logistic regression analyses were performed. Median prostate volume was 121 mL (IQR 108-142), and median follow-up was 58 months (IQR 46-60). Mean operative time was 121 ± 28 min, while estimated blood loss was 152 ± 70 mL. Major complications (Clavien-Dindo ≥ III) occurred in 4.5% of patients. Positive surgical margins were observed in 15.9%, and pT3 disease was identified in 46.2%. Five-year BCRFS, OS, and CSS were 79.8% and 95.8%, respectively. Urinary continence recovery reached 84.1% at 12 months and 90.6% at 5 years. Erectile function recovery among patients undergoing bilateral nerve-sparing was 48.6% at 12 months and 62.3% at 5 years. On multivariable analysis, Gleason score ≥ 8 (HR 2.63, p < 0.001), pT3 stage (HR 3.02, p < 0.001), and positive surgical margins (HR 2.11, p = 0.01) independently predicted biochemical recurrence. Bilateral nerve-sparing independently predicted improved continence recovery (OR 1.82, p = 0.02). RARP in patients with large-volume prostates is safe and oncologically effective, with favorable long-term functional outcomes. Tumor biology rather than prostate size appears to be the principal determinant of oncologic outcomes.

PMID:
42474561
Bibliographic data and abstract were imported from PubMed on 20 Jul 2026.

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