Outcomes of Robotic Prostatectomy with Lymph Node Removal and Early Hormone Therapy for Locally Advanced Prostate Cancer (pT3-4N0-1M0)

Purpose To investigate the efficacy and safety of robot-assisted radical prostatectomy (RARP) combined with extended pelvic lymph node dissection (ePLND) and immediate androgen deprivation therapy (ADT) for patients with locally advanced or lymph node metastatic prostate cancer (pT3-4N0-1M0). Methods We retrospectively analyzed clinical data from 40 patients with pT3-4N0-1M0 prostate cancer treated between April 2021 and April 2024. All patients had preoperative PSA > 20 ng/mL and received RARP + ePLND followed by immediate ADT. Postoperative follow-up ranged from 12 to 48 months, with records of surgical parameters, complications, urinary continence recovery, and biochemical recurrence. Results Operative time (207.4 ± 70.7 min), intraoperative blood loss (111.7 ± 127.8 mL), positive surgical margin rate (17.5%), and overall complication rate (10.0%) were all within acceptable ranges. Median postoperative hospitalization and catheter indwelling times were 7 and 22 days, respectively. Urinary continence recovery rates at 1, 3, 6, and 12 months were 62.5%, 85.0%, 90.0%, and 95.0%. During follow-up, one patient with positive margins (R1) and positive lymph nodes (N1) experienced biochemical recurrence at 3 years postoperatively, while one R1 but node-negative (N0) patient recurred at 4 years. Conclusion RARP + ePLND combined with immediate ADT is safe and feasible for treating locally advanced or lymph node metastatic prostate cancer (pT3-4N0-1M0), providing patients with favorable functional recovery and oncological outcomes.