For more than 20 years, after the introduction of the first robotic system, research on prostate cancer (PCa) surgery has mainly focused on evaluating outcomes of Robotic-Assisted Radical Prostatectomy (RARP). In the last few years, however, a new generation of innovative techniques, surgical approaches, and expanded indications have emerged. The Single Port (SP) robotic system was the first real hardware innovation in robotic surgery, and has already demonstrated advantages in terms of shorter length of stay, better cosmetic results and reduced postoperative pain. Artificial Intelligence (AI)-powered algorithms are being proposed as reliable tools for surgical assistance, aiding in standardization and mass implementation of robotic training. New surgical indications are emerging on the basis of patient and tumor characteristics. The extensive adoption of PCa screening and the precision of diagnostic tools have increased the rate of PCa diagnoses in a localized stage. Partial prostatectomy, despite needing further validation, has emerged as a safe and minimally invasive treatment option for confined tumors, able to minimize the side effects of prostate surgery. For locally advanced PCa, radioguided surgery has not only enhanced the oncological effectiveness of lymphadenectomy by enabling the precise identification and extraction of pathological lymph nodes, but has also contributed to minimizing the side effects associated with unnecessarily extensive dissections. Finally, in light of the increased efficacy of modern systemic therapies and the longer life expectancy, RP is currently being evaluated for primary tumor management in the metastatic phase. Despite the novelty of the aforementioned treatment options, they are already set to shape the future evolution of PCa management and international guidelines.
自首个机器人系统问世二十余年来，前列腺癌手术研究主要聚焦于机器人辅助根治性前列腺切除术的疗效评估。然而近年来，新一代创新技术、手术路径及拓展适应症不断涌现。单孔机器人系统作为机器人外科领域首个实质性硬件创新，已在缩短住院时间、改善美容效果及减轻术后疼痛方面展现出显著优势。基于人工智能的算法正成为可靠的手术辅助工具，推动机器人培训的标准化与规模化实施。基于患者与肿瘤特征的新型手术适应症正在形成：广泛开展的前列腺癌筛查与精准诊断工具的应用，提高了局限性前列腺癌的诊断率；针对局限性肿瘤的部分前列腺切除术虽需进一步验证，但已成为能最大限度减少手术副作用的微创治疗选择；对于局部进展期前列腺癌，放射引导手术不仅通过精准识别并切除病理淋巴结提升了淋巴结清扫的肿瘤学疗效，同时有效减少了过度广泛清扫带来的并发症。此外，鉴于现代全身治疗方案的疗效提升及患者预期寿命延长，根治性前列腺切除术目前正被评估用于转移期原发性肿瘤的治疗。尽管上述治疗方案尚属新兴领域，但已注定将重塑前列腺癌治疗的未来发展方向与国际指南体系。
肿瘤(癌症)患者之家