Comparison of Perioperative, Oncological, and Functional Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy With or Without Biopsy

Purpose: To compare perioperative, functional, and oncologic outcomes of biopsy-free radical prostatectomy (BF-RP) vs conventional radical prostatectomy (C-RP) in patients with suspected prostate cancer. Materials and Methods: This retrospective study included patients undergoing radical prostatectomy at Tongji Hospital from January 2022 to December 2024. After 1:1 propensity score matching for preoperative PSA and pathological T stage, 108 BF-RP and 108 C-RP patients were analyzed. BF-RP was defined as prostatectomy without prior biopsy, based on mpMRI (PI-RADS ≥ 4) and multidisciplinary team consensus. Outcomes included urinary continence (≤1 pad/day), sexual function (IIEF-5 ≥ 17), perioperative metrics, complications, and biochemical recurrence within 1 year. Results: BF-RP patients had shorter hospital stays (median 5 vs 6 days, P < .001) and earlier drain removal (4 vs 5 days, P = .0356). No significant differences were found in operative time, blood loss, transfusion, or positive margins (46.3% vs 51.9%, P = .4963). Complication rates were similar (11.1% vs 14.8%, P = .544). Urinary continence favored BF-RP at 2 weeks (35.2% vs 15.7%, P = .0011) and 3 months (83.3% vs 66.7%, P = .0042). While not reaching statistical significance, patients undergoing BF-RP demonstrated a favorable trend toward earlier recovery of sexual function and improved biochemical recurrence-free survival. Conclusions: In patients with prostate cancer, BF-RP demonstrates oncologic control and complication rates comparable with those of conventional surgery. It may also be associated with improved early recovery of sexual function and urinary continence, as well as shorter catheterization and hospital stays. These findings suggest the potential of BF-RP as an alternative approach for select patients; however, prospective studies are needed to further validate these results.