Advances in Techniques in Radical Prostatectomy

TL;DR

This paper reviews the evolution of radical prostatectomy techniques, highlighting advancements that improve cancer treatment outcomes while reducing complications.

Contribution

The paper provides a comprehensive overview of recent innovations and challenges in radical prostatectomy techniques.

Findings

Minimally invasive and robotic-assisted techniques have reduced postoperative complications like incontinence and erectile dysfunction.

Technological innovations such as augmented reality and PSMA PETs are improving surgical precision and margin assessment.

Challenges remain, including a steep learning curve for new techniques and disparities in access due to cost.

Abstract

Since its development in 1904, radical prostatectomy (RP) has remained a fundamental surgical option in the management of localised prostate cancer. Over time, continuous advancements in surgical techniques have improved oncological outcomes while reducing functional complications. This narrative review explores the evolution of RP, depicting its progression from the traditional open approach to minimally invasive laparoscopic and robotic-assisted techniques. Key developments in RP techniques, including nerve-sparing, bladder neck-sparing and Retzius-sparing techniques as well as enhanced perioperative management, have contributed to reduced postoperative complications, namely incontinence and erectile dysfunction. Additionally, technological innovations such as augmented reality, utilising indocyanine green for improved visualisation of prostatic boundaries and illuminare-1 to easily identify nerves intraoperatively, artificial intelligence, and novel molecular imaging technologies such as PSMA PETs for improved margin assessment are shaping the future of RPs. Despite these advancements, challenges persist, including a steep learning curve associated with newer techniques, disparities in access due to cost considerations, and a lack of standardised outcome measures across different surgical approaches. This review provides insight into current trends, ongoing challenges, and future directions that may further refine surgical precision, enhance patient safety, and improve long-term treatment success in prostate cancer management.

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