# Partial prostatectomy in prostate cancer: a systematic review of current evidence

## TL;DR

Partial prostatectomy may preserve urinary and sexual function in prostate cancer patients, but lacks strong evidence for routine use due to limited long-term data.

## Contribution

Systematic review of current evidence on partial prostatectomy for localized prostate cancer, highlighting gaps in clinical data.

## Key findings

- Partial prostatectomy showed 92%-100% urinary continence preservation but 28% biochemical recurrence rate.
- Erectile function preservation ranged from 40%-100%, raising concerns about functional outcomes.
- Overall and disease-free survival were 100%, but lack of randomized trials limits evidence strength.

## Abstract

•Partial prostatectomy shows promise but lacks evidence for routine clinical use.•Partial prostatectomy has emerged as a novel surgical option aiming to preserve urinary and sexual function while maintaining oncologic control in carefully selected patients with localized prostate cancer.•Early series suggest feasibility and safety, but long-term oncological outcomes remain uncertain compared with radical prostatectomy and focal therapies.

Partial prostatectomy shows promise but lacks evidence for routine clinical use.

Partial prostatectomy has emerged as a novel surgical option aiming to preserve urinary and sexual function while maintaining oncologic control in carefully selected patients with localized prostate cancer.

Early series suggest feasibility and safety, but long-term oncological outcomes remain uncertain compared with radical prostatectomy and focal therapies.

To evaluate the current evidence in the literature about partial prostatectomy as a treatment for localized prostate cancer.

A systematic search of nine databases was conducted up to December 2024 to identify studies involving patients with localized prostate cancer who underwent partial prostatectomy reporting clinical epidemiological characteristics, diagnostic strategies, histopathological findings, tumor staging, functional and oncological outcomes. The primary outcome was biochemical recurrence rate. Secondary outcomes were overall survival, disease-free survival, erectile dysfunction, urinary incontinence, and perioperative complications. The extracted data were systematically synthesized.

The authors analyzed five studies with a total of 48 patients (three prospective and two retrospective), all with low- or intermediate-risk disease. The mean surgical duration ranged from 129.2 to 208 min, with a single Clavien-Dindo Grade III complication reported. Only one study defined and reported biochemical recurrence, with a rate of 28 %. Urinary continence was preserved in 92 %–100 % of cases, while erectile function in 40 %–100 % ‒ which may represent a point of concern for this procedure. Overall survival and disease-free survival were consistently reported at 100 %. The lack of standardized reporting and the absence of randomized clinical trials prevented the performance of a meta-analysis and hindered the applicability of the findings to clinical practice.

Randomized clinical trials are still needed to provide stronger evidence regarding partial prostatectomy, as current data remain insufficient to support its routine use. With further research, partial prostatectomy may become an option for patients with favorable and intermediate-risk disease with unilateral lesions and concordance between magnetic resonance imaging and biopsy findings. Until then, radical prostatectomy remains the cornerstone of treatment for this patient profile.