Long-term Oncological Outcomes of Retzius-sparing Versus Anterior Robot-assisted Radical Prostatectomy: Post Hoc Analysis of a Randomized Cohort
In brief
Retzius-sparing prostatectomy lowers 5-year cancer-free survival to 80% versus 91% with standard
In a randomized trial of 120 men with low- to intermediate-risk prostate cancer, the Retzius-sparing robotic approach achieved a 5-year progression-free survival of 80.2% compared with 91.1% for the conventional anterior technique. After adjusting for disease risk, the RS method was about 2.6 times more likely to progress, suggesting its oncologic durability may lag behind its continence benefits.
- Journal
- European urology oncology (Q1)
- Published
- 4 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Alfonso Santangelo, Wooju Jeong, Caro Silvani, Alex Stephens, Emanuele Montanari, Nicola Nicolai, et al.
- PMID
- 42697825
- DOI
- 10.1016/j.euo.2026.07.012
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 6 September 2026): Randomized trial comparing prostatectomy approaches
- Picked for Radiology, Radiation Oncology, Nuclear Medicine, Medical Physics and Imaging (top studies of the week, 6 September 2026): Prostatectomy oncologic outcomes, no imaging or dosimetry
- Picked for Biochemistry (medical) (top studies of the week, 6 September 2026): Surgical outcomes, no metabolic focus
- Picked for Urology (top studies of the week, 6 September 2026): Randomized trial comparing Retzius-sparing vs anterior RARP outcomes
Abstract
BACKGROUND AND OBJECTIVE: The Retzius-sparing (RS) robot-assisted radical prostatectomy (RARP) was proposed in 2010 to enhance early postoperative continence recovery. However, long-term oncological outcomes following this approach remain insufficiently characterized. This study reports the long-term oncological outcomes of a randomized controlled trial originally designed to compare early continence recovery in patients treated using the RS versus standard (anterior) approach. DESIGN, SETTING, PARTICIPATNS AND INTERVENTION: A total of 120 men aged 40-75 yr with low- to intermediate-risk prostate cancer underwent RARP at a tertiary referral center. Patients were randomized 1:1 to the anterior or RS approach (n = 60 per arm). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary end point was progression-free survival (PFS), defined as biochemical recurrence and/or the need for any additional treatment. Kaplan-Meier plots were used to depict and compare PFS between the approaches. Cox regression was used to examine the impact of the approach on PFS after adjusting for the Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) scores. RESULTS AND LIMITATIONS: Median follow-up was 77 mo (interquartile range 30-110). At 5 yr, PFS was 80.2% in the RS group versus 91.1% in the anterior group (p = 0.01). After adjusting for CAPRA-S score, patients undergoing the RS approach were 2.64-fold more likely to experience progression (p = 0.049). The main limitations of this study stem from its original design, which did not consider long-term oncological outcomes as a primary end point, and from surgeons' limited prior experience with the RS approach. CONCLUSIONS: Although RS RARP provides superior early continence outcomes, patients randomized to this approach experienced less favorable long-term oncological control, potentially because of the increased technical demands of the procedure.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.