The trifecta outcome in prostate cancer surgery is a core measure for the assessment of prostatectomy techniques which constitutes oncological control, preservation of urinary continence, and erectile function preservation. Interpretation of trifecta outcomes is complex due to variation in patient selection, definitions, and follow-up protocols. This study aims to compare LRP (laparoscopic radical prostatectomy) and RARP (robot-assisted radical prostatectomy) in the management of prostate cancer, especially trifecta outcomes. A literature search was conducted using PubMed, Embase, and CINAHL databases to identify studies relevant to the topic from 2005 to May 2025. Studies that compared RARP and LRP in prostate cancer patients and reported at least one of the trifecta outcomes were included in this narrative review. Functional outcomes, patient satisfaction, and cost-effectiveness were the different themes for which data was synthesized. Early outcomes in urinary incontinence and erectile function showed better recovery with RARP when compared to LRP, specifically within the first 12 months postoperatively. Within the two approaches, oncological outcomes such as positive surgical margin and biochemical recurrence were comparable. There was reduced postoperative pain, faster recovery, and higher satisfaction scores associated with RARP. However, there are significant barriers to adoption of RARP like high cost and limited access particularly in low- and middle-income countries. The choice between RARP and LRP should be individualized. Further research should focus on integrating AI, AR and ePROMSs to improve surgical care. RARP offers advantages in early functional recovery, while long-term oncological outcomes remain comparable between techniques.
IntroductionAndrogen deprivation therapy (ADT) is a cornerstone of prostate cancer treatment and is commonly accompanied by longitudinal changes in muscle, adipose tissue, and skeletal health that may be poorly captured by conventional anthropometric measures. This study investigated whether routine oncologic computed tomography (CT) could provide an integrated longitudinal assessment of muscle, adipose tissue, and vertebral trabecular attenuation following ADT initiation.MethodsIn this retrospective, single-center longitudinal study, 60 consecutive men with prostate cancer initiating ADT between January 2023 and May 2025 were screened at Antonio Perrino Hospital, Brindisi, Italy, with clinical follow-up available through July 2026. Forty patients with an eligible baseline CT obtained within 30 days before ADT initiation and a technically comparable follow-up CT at 12 ± 2 months were included. At L3, skeletal muscle index (SMI), bilateral psoas attenuation, subcutaneous adipose tissue index (SATI), and visceral adipose tissue index (VATI) were assessed. Trabecular vertebral attenuation was measured at L1–L3. ResultsMean SMI decreased from 48.4 ± 6.9 to 45.5 ± 6.8 cm²/m² (−6.0%; p<0.001), while mean psoas attenuation decreased from 41.0 ± 5.9 to 37.8 ± 6.0 HU (−7.8%; p<0.001). SATI increased by 11.6% (p<0.001), VATI by 6.2% (p=0.018), and mean vertebral trabecular attenuation decreased by 4.4% (p=0.006). BMI changed only modestly and showed a weak relationship with SMI change. Twenty-three patients (57.5%) had an SMI decline ≥5%, a prespecified exploratory threshold. In an exploratory parsimonious adjusted analysis, lower baseline psoas attenuation was associated with subsequent SMI decline ≥5%; however, the limited sample size precludes interpretation as an independent predictive biomarker. DiscussionRoutine oncologic CT demonstrated concurrent longitudinal changes in muscle, adipose tissue, and vertebral attenuation following ADT initiation that were only weakly reflected by BMI. These findings support further evaluation of integrated opportunistic CT phenotyping in larger controlled cohorts.
Introduction5-alpha-reductase inhibitors (5-ARIs), such as finasteride and dutasteride, are effective in reducing prostate volume and urinary symptoms; however, these drugs are associated with specific adverse events, including suicidal ideation, anxiety, and self-harm.MethodsA systematic review and meta-analysis of observational studies was conducted in PubMed, Embase and Web of Science on July 16, 2025, with no time restrictions. Studies involved individuals diagnosed with benign prostatic hyperplasia (BPH) or androgenetic alopecia (AGA), and experiencing suicide and neuropsychiatric events, including anxiety, depression and intentional self-harm (ISH) during the treatment with 5-ARIs. This study followed the PRISMA statement.ResultsEleven studies were included in the systematic review, of which nine were eligible for meta-analysis. Comparisons included 5-ARI users versus non-users or alpha-blocker users. Overall, no statistically significant differences were observed between groups (HR 1.07, 95% CI: 0.76–1.51), with substantial heterogeneity across studies (I² = 59%).ConclusionThis meta-analysis found no significant association between 5-ARIs and the risk of suicide or neuropsychiatric events in patients with benign prostatic hyperplasia or androgenetic alopecia. Nevertheless, given regulatory concerns regarding suicidal ideation, continued real-world monitoring through active surveillance and prospective observational studies remain warranted.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251106035, identifier CRD420251106035.
