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Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis

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To ascertain 3-year urinary continence (UC) and sexual function (SF) recovery following robot-assisted radical prostatectomy (RARP) for clinically high-risk prostate cancer (PCa).


Retrospective analyses of a prospectively maintained database for 769 patients with D’Amico high-risk PCa undergoing RARP at two tertiary care centers in the United States and Europe between 2001 and 2014. The association between time since RARP and recovery of UC (defined as 0 pad/one safety liner per day) and SF (defined as sexual health inventory for men (SHIM) score 17) was tested in separate preoperative and post-operative Cox-proportional hazards regression models. Sensitivity analyses were conducted using continence 0 pad per day and erection sufficient for intercourse as end points for UC and SF recovery, respectively.


Mean age of the cohort was 62.3 years, and 62.1% harbored PT3a disease. Nerve sparing (unilateral or bilateral) RARP was performed in 87.7% of patients. Kaplan–Meier estimates of UC recovery at 12, 24 and 36 months after surgery was 85.2%, 89.1% and 91.2%, respectively, while 33.8, 52.3 and 69.0% of preoperatively potent men (preoperative SHIM 17; n=548; 71.3%) recovered SF. Similar results were noted in sensitivity analyses. Patient age and year of surgery were associated with UC and SF recovery; additionally, preoperative SHIM score, degree of nerve sparing, pT3b-T4 disease and surgical margins were associated with SF recovery over the period of observation.


Patients with D’Amico high-risk PCa treated with RARP may continue to recover UC and SF beyond 12 months of surgery and show promising outcomes at 3-year follow-up. Appropriate patient selection and counseling may aid in setting realistic expectations for functional recovery post RARP.

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  1. 1

    Siegel RL, Miller KD, Jemal A . Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5–29.

  2. 2

    Cooperberg MR, Cowan J, Broering JM, Carroll PR . High-risk prostate cancer in the United States, 1990-2007. World J Urol 2008; 26: 211–218.

  3. 3

    Moyer VA . Screening for prostate cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med 2012; 157: 120–134.

  4. 4

    Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M et al. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol 2012; 61: 679–685.

  5. 5

    Lavery HJ, Nabizada-Pace F, Carlucci JR, Brajtbord JS, Samadi DB . Nerve-sparing robotic prostatectomy in preoperatively high-risk patients is safe and efficacious. Urol Oncol 2012; 30: 26–32.

  6. 6

    Ou YC, Yang CK, Wang J, Hung SW, Cheng CL, Tewari AK et al. The trifecta outcome in 300 consecutive cases of robotic-assisted laparoscopic radical prostatectomy according to D'Amico risk criteria. Eur J Surg Oncol 2013; 39: 107–113.

  7. 7

    Jayram G, Decastro GJ, Large MC, Razmaria A, Zagaja GP, Shalhav AL et al. Robotic radical prostatectomy in patients with high-risk disease: a review of short-term outcomes from a high-volume center. J Endourol 2011; 25: 455–457.

  8. 8

    Recabal P, Assel M, Musser JE, Caras RJ, Sjoberg DD, Coleman JA et al. Erectile function recovery after radical prostatectomy in men with high-risk features. J Urol 2016; 196: 507–513.

  9. 9

    Sivarajan G, Prabhu V, Taksler GB, Laze J, Lepor H . Ten-year outcomes of sexual function after radical prostatectomy: results of a prospective longitudinal study. Eur Urol 2014; 65: 58–65.

  10. 10

    Prabhu V, Sivarajan G, Taksler GB, Laze J, Lepor H . Long-term continence outcomes in men undergoing radical prostatectomy for clinically localized prostate cancer. Eur Urol 2014; 65: 52–57.

  11. 11

    Menon M, Tewari A, Peabody J . Vattikuti Institute prostatectomy: technique. J Urol 2003; 169: 2289–2292.

  12. 12

    Mattei A, Fuechsel FG, Bhatta Dhar N, Warncke SH, Thalmann GN, Krause T et al. The template of the primary lymphatic landing sites of the prostate should be revisited: results of a multimodality mapping study. Eur Urol 2008; 53: 118–125.

  13. 13

    Stamey TA, Yemoto CM, McNeal JE, Sigal BM, Johnstone IM . Prostate cancer is highly predictable: a prognostic equation based on all morphological variables in radical prostatectomy specimens. J Urol 2000; 163: 1155–1160.

  14. 14

    Menon M, Kaul S, Bhandari A, Shrivastava A, Tewari A, Hemal A . Potency following robotic radical prostatectomy: a questionnaire based analysis of outcomes after conventional nerve sparing and prostatic fascia sparing techniques. J Urol 2005; 174: 2291–2296.

  15. 15

    Mulhall JP . Defining and reporting erectile function outcomes after radical prostatectomy: challenges and misconceptions. J Urol 2009; 181: 462–471.

  16. 16

    Kaplan EL, Meier P . Nonparametric estimation from incomplete observations. J Amer Statist Assn 1958; 53: 457–481.

  17. 17

    Pearce S, Pariser J, Karrison T, Patel S, Eggener S . Comparison of perioperative and early oncologic outcomes between open and robotic-assisted laparoscopic prostatectomy in a contemporary population based cohort. J Urol 2016; 196: 76–81.

  18. 18

    Rogers CG, Sammon JD, Sukumar S, Diaz M, Peabody J, Menon M . Robot assisted radical prostatectomy for elderly patients with high risk prostate cancer. Urol Oncol 2013; 31: 193–197.

  19. 19

    Lee JK, Assel M, Thong AE, Sjoberg DD, Mulhall JP, Sandhu J et al. Unexpected long-term improvements in urinary and erectile function in a large cohort of men with self-reported outcomes following radical prostatectomy. Eur Urol 2015; 68: 899–905.

  20. 20

    Abdollah F, Sood A, Sammon JD, Hsu L, Beyer B, Moschini M et al. Long-term cancer control outcomes in patients with clinically high-risk prostate cancer treated with robot-assisted radical prostatectomy: results from a multi-institutional study of 1100 patients. Eur Urol 2015; 68: 497–505.

  21. 21

    Abdollah F, Sun M, Suardi N, Gallina A, Bianchi M, Tutolo M et al. Prediction of functional outcomes after nerve-sparing radical prostatectomy: results of conditional survival analyses. Eur Urol 2012; 62: 42–52.

  22. 22

    Novara G, Ficarra V, D'Elia C, Secco S, Cioffi A, Cavalleri S et al. Evaluating urinary continence and preoperative predictors of urinary continence after robot assisted laparoscopic radical prostatectomy. J Urol 2010; 184: 1028–1033.

  23. 23

    Shikanov S, Desai V, Razmaria A, Zagaja GP, Shalhav AL . Robotic radical prostatectomy for elderly patients: probability of achieving continence and potency 1 year after surgery. J Urol 2010; 183: 1803–1807.

  24. 24

    Zorn KC, Wille MA, Thong AE, Katz MH, Shikanov SA, Razmaria A et al. Continued improvement of perioperative, pathological and continence outcomes during 700 robot-assisted radical prostatectomies. Can J Urol 2009; 16: 4742–4749.

  25. 25

    Menon M, Shrivastava A, Bhandari M, Satyanarayana R, Siva S, Agarwal PK . Vattikuti Institute prostatectomy: technical modifications in 2009. Eur Urol 2009; 56: 89–96.

  26. 26

    Sammon JD, Trinh QD, Sukumar S, Diaz M, Simone A, Kaul S et al. Long-term follow-up of patients undergoing percutaneous suprapubic tube drainage after robot-assisted radical prostatectomy (RARP). BJU Int 2012; 110: 580–585.

  27. 27

    Briganti A, Di Trapani E, Abdollah F, Gallina A, Suardi N, Capitanio U et al. Choosing the best candidates for penile rehabilitation after bilateral nerve-sparing radical prostatectomy. J Sex Med 2012; 9: 608–617.

  28. 28

    Michl U, Tennstedt P, Feldmeier L, Mandel P, Oh SJ, Ahyai S et al. Nerve-sparing surgery technique, not the preservation of the neurovascular bundles, leads to improved long-term continence rates after radical prostatectomy. Eur Urol 2016; 69: 584–589.

  29. 29

    Ficarra V, Novara G, Rosen RC, Artibani W, Carroll PR, Costello A et al. Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 405–417.

  30. 30

    Yaxley JW, Coughlin GD, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L et al. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057–1066.

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Correspondence to F Abdollah.

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Competing interests

F Abdollah is a consultant/advisor of GenomeDx Biosciences. The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Prostate Cancer and Prostatic Diseases website

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Abdollah, F., Dalela, D., Sood, A. et al. Functional outcomes of clinically high-risk prostate cancer patients treated with robot-assisted radical prostatectomy: a multi-institutional analysis. Prostate Cancer Prostatic Dis 20, 395–400 (2017) doi:10.1038/pcan.2017.26

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