To evaluate the impact of Retzius-sparing robot-assisted radical prostatectomy (posterior approach) on early recovery of urinary continence (UC) compared to the conventional approach (anterior approach) for the treatment of clinically localized prostate cancer (PCa). Methods A total of 110 consecutive patients with clinically localized PCa were prospectively randomized in a 1:1 ratio to an anterior group (n = 55) or a posterior group (n = 55). The primary outcome was immediate UC, defined as freedom from any pad use within 1 week after removal of the urinary catheter. The UC rate following surgery was also calculated with Kaplan-Meier curves, and the log-rank test was used for statistical comparison. Intra-operative outcomes, pathological data and oncological outcomes, including positive surgical margin (PSM) status and biochemical recurrence-free survival (BCRFS), were also compared between the two groups. The comparison of the two approaches was also analysed in subgroups after risk stratification. Results Of the patients who underwent the posterior approach, 69.1% achieved immediate UC compared with 30.9% in the anterior group (relative risk 2.24, 95% confidence interval [CI] 1.48-3.51; P = 0.000). The relative Kaplan-Meier curves for UC during the 12-month follow-up revealed statistically better recovery in the posterior group when compared with the anterior group (hazard ratio [HR] 1.51, 95% CI 1.01-2.24; log-rank P = 0.007). No statistically significant differences were observed between the groups regarding complications (P = 0.399), PSM status (P = 0.225) or BCRFS (HR 4.80, 95% CI 0.97-23.78; log-rank P = 0.111). In sub-analyses, no significant difference between the two approaches with regard to UC recovery in patients with high-risk PCa was observed (HR 1.26, 95% CI 0.63-2.51; log-rank P = 0.415). Conclusions The Retzius-sparing approach significantly improved early recovery of UC compared to the conventional approach. Further prospective studies are needed to confirm the benefits of the Retzius-sparing approach for clinically localized PCa, especially for high-risk cases.

Objective To explore the preoperative predictors of the progression to prostate cancer after diagnosing with highgrade prostatic intraepithelial neoplasia (HGPIN) or atypical small acinar proliferation (ASAP) in first prostate biopsy and compare the oncological outcomes of HGPIN and ASAP in second prostate biopsy. Methods Data from 175 patients who were diagnosed with HGPIN or ASAP in first prostate biopsy and received second prostate biopsy were retrospectively collected. Propensity-score matching was performed using six preoperative variables, and postoperative variables were compared between two groups. Results A total of 41 patients (23.4%) were diagnosed with prostate cancer in second biopsy. There were no significant differences in age, body mass index (BMI), prostate volume, ECOG performance status and first biopsy pathology between prostate cancer (PCa) group and non-PCa group. Preoperative serum PSA was significantly higher in PCa group than in no-PCa group (12.99 (IQR 6.56–31.31) vs. 7.18 (3.23–19.54) ml, p<0.001). Furthermore, PCa group had higher PI-RADS score of preoperative multiparameter magnetic resonance imaging (mpMRI) than non-PCa group (1 point 7.3% vs. 23.1%, 2 points 29.3% vs. 45.5%, 3 points 56.1% vs. 29.1%, 4 points 4.9% vs. 2.3%, 5 points 2.4% vs. 0%, P = 0.002). On univariable and multivariable analysis, preoperative serum PSA(OR 1.598, p<0.001) and PI-RADS score (OR 2.029, p = 0.025) (compared with low PI-RADS score) were independent predictors of progression to prostate cancer in second biopsy. Meanwhile, no statistically significant differences of second biopsy were observed between the HGPIN group and ASAP group about oncological outcomes (malignant rate, Gleason score, number of positive biopsy needles). Conclusions Preoperative serum PSA and PI-RADS score of preoperative multiparameter magnetic resonance imaging were independent predictors of progression to prostate cancer in second biopsy. Oncological outcomes of malignant second biopsy were similar although with different first biopsy pathologies (HGPIN or ASAP).

sensitivity for PSMA SPECT/CT was 70% and the specificity was 91%. On a patient-based analysis, the sensitivity was 83% and the specificity was 90%. After the surgery, prostate specific antigen(PSA) level declined in 46 patients and increased in 1 patient. During the follow-up period (range: 3-16 months), of the 14 patients who presented with pelvic metastatic lymph nodes, 12 remained biochemical response (BR) after the surgery, 1 became biochemical recurrence (BCR) following BR, and 1 never became BR. While of the 4 patients with retroperitoneal LNMs, 2 became BCR following BR, and 2 never became BR. PSMAguided sLND delayed disease progression in 5 of 6 patients and these patients experienced a decline of PSA for about half an year.CONCLUSIONS: 99mTc-PSMA SPECT/CT guided surgery in PCa patients was safe and reliable with high sensitivity and specificity. sLND may represent a more suitable approach for patients with PCa recurrence. Patients with pelvic lymph node metastasis may benefit more from PSMA SPECT/CT guided surgery than those with retroperitoneal lymph node metastasis.