Keynote Presentation: The Evolving Paradigm of Prostate Cancer Surgery: Lessons Learned from 17,000 RALP's

We started our experience with prostate cancer in 2002 with primitive robotic platforms. Our main goal was to provide an alternative to open and laparoscopic surgery. In this scenario, the evolution of new platforms optimized and improved surgical outcomes, and robotic surgery became the standard of care in centers with access to this technology.

Even with technological improvements and several robotic platforms in the market, the treatment of prostate cancer is still challenging because it depends on numerous factors such as patient age, sexual function, tumor histology and staging, surgical technique, and patient compliance with postoperative rehabilitation protocols.

Furthermore, in recent years, we have witnessed some changes in the oncologic nature of prostate cancer and an increase in more aggressive tumors, which negatively affected postoperative functional and oncological outcomes. In this context, we modified our surgical technique several times to maintain our positive surgical margin rates and provide optimal oncological treatment for our patients.

Our team has been publishing several scientific articles describing our surgical technique and outcomes of postoperative recovery of potency, continence, and cancer control. However, prostate cancer still challenges patients and surgeons, and we are still working hard to provide and improve outcomes. There is a trend toward operating on higher-risk patients, large-volume tumors, oligometastatic tumors, and salvage surgery due to increasing rates of these cases in recent years. Technical modifications have also allowed us to keep margins and short-term oncologic outcomes stable. However, the quality of the candidates for full nerve-sparing surgery has reduced.

In the near future, we foresee a continued increase in high-risk and metastatic prostate cancer. We believe educating our PCP physicians and Urologists to perform PSA screening and DRE is important to reduce the rates of aggressive cancers, and advanced imaging such as PSMA PET will play a role in stratifying patients who will and will not benefit from local surgery or radiation therapy.

Learning Objectives:

1. Evaluate and analyze the surgical techniques and methodology behind complex robotic prostate cancer surgeries.

2. Describe the key complications and outline the intra-operative and post-operative management related to robotic prostatectomy using video-based learning and didactic presentation.

3. Demonstrate current and upcoming protocols for regaining potency and continence following robotic prostatectomy.