Objective: This study aimed to explore the benefits of theranostic robot-assisted radical prostatectomy (T-RARP) for clinically highly suspicious prostate cancer (PCa) without proven biopsies. Material and Methods: Between February 2016 and December 2020, we included men with clinically highly suspicious PCa in this study. They were assessed to have possible localized PCa without any initial treatments, and were categorized into previous benign biopsies or without biopsies. Furthermore, another group of malignant biopsies with RARP in the same time frame was adopted as the control group. The endpoints were to compare the oncological outcome and functional outcome between malignant biopsies with RARP and T-RARP.p< 0.05 was considered to be significant. Results: We included 164 men with proven malignant biopsies treated with RARP as the control group. For T-RARP, we included 192 men. Among them, 129 were preoperatively benign biopsies, and 63 had no biopsies before T-RARP. Approximately 75% of men in the T-RARP group had malignant pathology in their final reports, and the other 25% had benign pathology. T-RARP provides several oncological advantages, such as a higher initial pathological T stage, lower Gleason grade, and lower odds of positive surgical margins. However, the biochemical recurrence rates were not significantly decreased. From our cohort, T-RARP (odds ratio with 95% confidence interval; erectile recovery: 3.19 (1.84–5.52),p< 0.001; continence recovery: 2.25 (1.46–3.48),p< 0.001) could result in better recovery of functional outcomes than malignant biopsies with RARP. Conclusions: For clinically highly suspicious PCa, T-RARP was able to detect around 75% of PCa cases and preserved their functional outcomes maximally. However, in 25% of men with benign pathology, approximately 6% would have incontinence and 10% would have erectile impairment. This part should be sufficiently informed of the potential groups considering T-RARP.
目的：本研究旨在探讨诊疗一体化机器人辅助根治性前列腺切除术（T-RARP）对临床高度怀疑但活检未证实的前列腺癌（PCa）患者的益处。材料与方法：2016年2月至2020年12月期间，我们纳入了临床高度怀疑PCa的男性患者。这些患者经评估可能患有局限性PCa且未接受任何初始治疗，并被分为既往良性活检组和无活检组。此外，同期另一组经活检证实为恶性并行RARP的患者被作为对照组。研究终点是比较恶性活检RARP组与T-RARP组在肿瘤学结果和功能结果上的差异，p<0.05被认为具有统计学意义。结果：我们纳入了164例经活检证实为恶性并接受RARP治疗的男性作为对照组。T-RARP组共纳入192例男性，其中129例术前活检为良性，63例在T-RARP前未进行活检。T-RARP组中约75%的男性最终病理报告为恶性，其余25%为良性病理。T-RARP在肿瘤学方面具有多项优势，例如更高的初始病理T分期、更低的格里森分级以及更低的手术切缘阳性率。然而，生化复发率并未显著降低。从我们的队列数据来看，与恶性活检RARP组相比，T-RARP（比值比及95%置信区间；勃起功能恢复：3.19（1.84–5.52），p<0.001；控尿功能恢复：2.25（1.46–3.48），p<0.001）能够带来更好的功能恢复结果。结论：对于临床高度怀疑的PCa，T-RARP能够检测出约75%的PCa病例，并最大程度地保留患者的功能预后。然而，在25%病理结果为良性的男性中，约6%可能出现尿失禁，10%可能出现勃起功能障碍。考虑接受T-RARP的潜在人群应充分了解这部分风险。
Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood
肿瘤(癌症)患者之家