Meta-analysis of radical prostatectomy outcomes: Oncological control and functional recovery in prostate cancer patients

Abstract

BACKGROUND: Prostate cancer is a global health concern. Radical prostatectomy (RP) is a key treatment, but there are debates about its surgical approaches regarding oncological control and functional recovery. Existing literature is limited by heterogeneous outcome definitions such as urinary continence, short follow-up, and methodological variability, necessitating an updated evidence synthesis. To comprehensively evaluate the efficacy of RP in cancer control and the recovery of urinary/sexual function. METHODS: A PRISMA-guided meta-analysis was conducted on studies published between 2015 and 2025. Multiple databases were searched, and data on oncological (e.g., biochemical recurrence, survival) and functional outcomes (e.g., continence, erectile function) were extracted. Rigorous quality assessment and statistical analysis were performed. RESULTS: Robotic-assisted radical prostatectomy (RARP) outperformed laparoscopic radical prostatectomy in oncological outcomes: lower biochemical recurrence (risk difference [RD] = -0.09, 95% CI: -0.14 to -0.03) and better prostate-specific antigen control (standardized mean difference [SMD] = -0.3, 95% CI: -0.89 to -0.77). Functionally, RARP improved erectile recovery (IIEF-5 mean difference = 1.07, 95% CI: 0.76-1.38). Urinary continence reporting remained inconsistent across studies, hindering cross-comparison. CONCLUSION: RP can achieve good oncological control, but it is essential to balance functional preservation. RARP appears to be more favorable in both aspects. Tailored strategies-integrating preoperative risk stratification, such as Gleason score, and prostate-specific antigen levels-and standardized postoperative rehabilitation are critical. Future research should focus on standardized outcome reporting and long-term follow-up.