Perioperative outcomes and postoperative functional outcomes of robot-assisted radical prostatectomy for oligometastatic versus localized prostate cancer: a multicenter matched case-control study.

[BACKGROUND] As treatment for oligometastatic prostate cancer (OmPCa) gains increasing attention, the safety of robot-assisted radical prostatectomy (RARP) in this patient population has sparked growing interest. This study aimed to compare the perioperative outcomes and postoperative functional outcomes of RARP between patients with OmPCa and those with localized prostate cancer (LPCa), and to evaluate the safety and feasibility of RARP in OmPCa patients.

[METHODS] This multicenter, retrospective, case-control study included 100 OmPCa patients (defined as having ≤5 bone and/or lymph node metastases, excluding visceral metastases) who underwent RARP between March 2010 and December 2023 at five hospital centers in China. For comparison, 100 LPCa patients were matched 1:1 to the OmPCa group based on the surgical center and operative date. Perioperative and postoperative functional outcomes were compared between the two groups.

[RESULTS] The OmPCa group exhibited significantly higher median preoperative prostate-specific antigen (PSA) levels (22.63 19.09 ng/mL, P=0.006), higher median biopsy Gleason scores (8 7, P=0.007), and a greater proportion of clinical T stage > T2c (65% 42%, P=0.02) compared to the LPCa group, with no significant differences in other baseline characteristics (all P>0.05). Comparisons of perioperative outcomes revealed no significant differences between the OmPCa and LPCa groups in operative time (154 150 minutes, P=0.37), estimated blood loss (100 100 mL, P=0.53), postoperative hospital stay (5 4 days, P=0.08), positive surgical margin (PSM) rate (19.0% 13.0%, P=0.36), or 30-day complication rate (4.0% 2.0%, P=0.41). Regarding functional outcomes, the Expanded Prostate Cancer Index Composite (EPIC) urinary incontinence (UI) domain scores at 3 and 12 months postoperatively, as well as the UI recovery rates at 1, 3, and 12 months, showed no significant differences between the two groups (all P>0.05). However, the OmPCa group demonstrated significantly poorer EPIC sexual domain scores at 3 and 12 months postoperatively, along with a significantly higher incidence of erectile dysfunction (ED) at 12 months, compared to the LPCa group (all P<0.05).

[CONCLUSIONS] This study demonstrates that compared to LPCa patients, RARP does not increase the risk of perioperative adverse outcomes or postoperative functional decline in patients with OmPCa. This finding provides evidence for expanding the surgical indications for RARP in the treatment of OmPCa.