Long-term Oncological Outcomes of Retzius-sparing Versus Anterior Robot-assisted Radical Prostatectomy: Post Hoc Analysis of a Randomized Cohort.

Authors

Alfonso Santangelo, Wooju Jeong, Caro Silvani, Alex Stephens, Emanuele Montanari, Nicola Nicolai, Alberto Briganti, Francesco Montorsi, Craig Rogers, Mani Menon, Firas Abdollah

Published in

European urology oncology. Sep 04, 2026. Epub Sep 04, 2026.

Abstract

The Retzius-sparing (RS) robot-assisted radical prostatectomy (RARP) was proposed in 2010 to enhance early postoperative continence recovery. However, long-term oncological outcomes following this approach remain insufficiently characterized. This study reports the long-term oncological outcomes of a randomized controlled trial originally designed to compare early continence recovery in patients treated using the RS versus standard (anterior) approach.
A total of 120 men aged 40-75 yr with low- to intermediate-risk prostate cancer underwent RARP at a tertiary referral center. Patients were randomized 1:1 to the anterior or RS approach (n = 60 per arm).
The primary end point was progression-free survival (PFS), defined as biochemical recurrence and/or the need for any additional treatment. Kaplan-Meier plots were used to depict and compare PFS between the approaches. Cox regression was used to examine the impact of the approach on PFS after adjusting for the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) scores.
Median follow-up was 77 mo (interquartile range 30-110). At 5 yr, PFS was 80.2% in the RS group versus 91.1% in the anterior group (p = 0.01). After adjusting for CAPRA-S score, patients undergoing the RS approach were 2.64-fold more likely to experience progression (p = 0.049). The main limitations of this study stem from its original design, which did not consider long-term oncological outcomes as a primary end point, and from surgeons' limited prior experience with the RS approach.
Although RS RARP provides superior early continence outcomes, patients randomized to this approach experienced less favorable long-term oncological control, potentially because of the increased technical demands of the procedure.

PMID:
42697825
Bibliographic data and abstract were imported from PubMed on 05 Sep 2026.

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