Early functional and oncological outcomes after robot-assisted radical prostatectomy in D'Amico high-risk prostate cancer: a prospective cohort study.

BACKGROUND: Robot-assisted radical prostatectomy (RARP) is an established treatment option for D'Amico high-risk prostate cancer within multimodal therapy concepts. While oncological outcomes are well documented, data on very early functional recovery remain limited. This prospective study evaluated early continence outcomes and biochemical recurrence (BCR)-free survival after RARP in D'Amico high-risk patients. METHODS: Clinical, pathological, functional, and follow-up data from patients undergoing RARP between February 2021 and May 2024 were prospectively collected. Among 361 consecutive patients, 109 met D'Amico high-risk criteria and were included. Pre-operative variables included prostate-specific antigen (PSA), prostate volume, biopsy Gleason grade group, and clinical stage. Pathological outcomes comprised tumor stage, surgical margin status, lymph node involvement, and post-operative PSA nadir. Early continence was assessed using a standardized post-operative pad test and BCR-free survival was analyzed using Kaplan- Meier analysis. RESULTS: Median pre-operative PSA was 9.8 ng/mL, and most patients had biopsy Gleason grade group ≥ 3. Locally advanced disease predominated, with pT3a and pT3b tumors in 56.9% and 32.1% of patients, respectively. Positive surgical margins occurred in 36.7% of cases, while 61.5% achieved a PSA nadir of 0.01 ng/mL. After a median follow-up of 30.8 months, BCR occurred in 22.9% of patients. Serious peri-operative complications (Clavien-Dindo ≥ III) were rare (2.8%). Gleason score and tumor stage were significantly associated with BCR, and early pad test results strongly predicted continence at one year. CONCLUSIONS: RARP provided acceptable early continence recovery and meaningful oncological control in D'Amico high-risk prostate cancer, supporting its role within multimodal treatment strategies.