Robot-Assisted Radical Prostatectomy in Locally Advanced Prostate Cancer

One quarter of newly diagnosed prostate cancers (PCa) are locally-advanced (LA): if managed with non-curative intent, one third would die from the disease. Guidelines recommend combining local treatment with systemic therapy, in fit patients. Though, radical prostatectomy (RP) is still underused. In this setting, local excision alone is inadequate as most men will experience disease relapse. Since neoadjuvant treatment with luteinizing hormone-releasing hormone agonists did not improve survival, the role of Androgen Receptor-Targeted Agents is being assessed. We described prostate surgical anatomy and our technique of extrafascial robot-assisted RP, specifically conceived to manage LA-PCa cases, minimizing the risk of complications, positive surgical margins, and recurrence.