Prostate cancer in Asia:A collaborative report

The incidence of prostate cancer(PCa)within Asian population used to be much lower than in the Western population;however,in recent years the incidence and mortality rate of PCa in some Asian countries have grown rapidly.This collaborative report summarized the latest epidemiology information,risk factors,and racial differences in PCa diagnosis,current status and new trends in surgery management and novel agents for castration-resistant prostate cancer.We believe such information would be helpful in clinical decision making for urologists and oncologists,health-care ministries and medical researchers.

Current status of diagnosis and treatment of bladder cancer in China-Analyses of Chinese Bladder Cancer Consortium database

Objective:To investigate current status of diagnosis and treatment of bladder cancer in China.Methods:A database was generated by Chinese Bladder Cancer Consortium(CBCC).From January 2007 to December 2012,14,260 cases from 44 CBCC centers were included.Data of diagnosis,treatment and pathology were collected.Results:The average age was 63.5 year-old and most patients were male(84.3%).The most common histologic types were urothelial carcinoma(91.4%),adenocarcinoma(1.8%),and squamous carcinoma(1.9%).According to 1973 and 2004 WHO grading system,42.0%,41.0%,and 17.0% of patients were grade 1,2,and 3,and 16.0%,48.7%,and 35.3% of patients were papillary urothelial neoplasms of low malignant potential,low,and high grade,respectively.Non-muscle invasive bladder cancer(NMIBC)and muscle invasive bladder cancer(MIBC)were 25.2% and 74.1%,respectively(0.8% not clear).Carcinoma in situ was only 2.4%.Most patients were diagnosed by white-light cystoscopy with biopsy(74.3%).Fluorescence and narrow band imaging cystoscopy had additional detection rate of 1.0% and 4.0%,respectively.Diagnostic transurethral resection(TUR)provided detection rate of 16.9%.Most NMIBCs were treated with TUR(89.2%).After initial TUR,2.6%accepted second TUR,and 45.7%,69.9%,and 58.7% accepted immediate,induced,and maintenance chemotherapy instillation,respectively.Most MIBCs were treated with radical cystectomy(RC,59.7%).Laparoscopic RCs were 35.1%,while open RC 63.4%.Extended and standard pelvic lymph node dissection were 7% and 66%,respectively.Three most common urinary diversions were orthotopic neobladder(44%),ileal conduit(31%),and ureterocutaneostomy(23%).Only 2.3% of patients accepted neo-adjuvant chemotherapy and only 18%of T3 and T4 patients accepted adjuvant chemotherapy.Conclusion:Disease characteristics are similar to international reports,while differences of diagnosis and treatment exist.This study can provide evidences for revisions of the guideline on bladder cancer in China.

Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): Initial experience

Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated prostate-specific antigen(PSA)level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3þ4=7.Multiparametric magnetic resonance(MR)and bone scintigraphy showed organ-confined disease.spRALP was performed using da Vinci Si HD surgical system,with access of a quadri-channel laparoscopic port placed supraumbilically.Two drainage tubes were placed before wound closure.The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy.Results:The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL.The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes.Foley catheter was removed on postoperative Day 14.No major complications were encountered.Postoperative pathology showed a Gleason score of 3þ4=7 with no extraprostatic extension and negative surgical margins.Conclusion:Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers.Meticulous preoperative planning and careful patient selection are mandatory.Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.

Percent free prostate-specific antigen for prostate cancer diagnosis in Chinese men with a PSA of 4.0-10.0 ng/mL:Results from the Chinese Prostate Cancer Consortium

Objective:To test the diagnostic performance of percent free prostate-specific antigen(%fPSA)in predicting any prostate cancer(PCa)and high-grade prostate cancer(HGPCa)in a retrospective multi-center biopsy cohort with a PSA level of 4.0e10.0 ng/mL in China.Methods:Consecutive patients with a PSA of 4.0-10.0 ng/mL who underwent transrectal ultrasound-guided biopsy were enrolled at 16 Chinese medical centers from January 1st,2010 to December 31st,2013.Total and free serum PSA determinations were performed using three types of electro-chemiluminescence immunoassays recalibrated to the World Health Organization(WHO)standard.The diagnostic accuracy of PSA,%fPSA,and %fPSA in combination with PSA(%fPSA t PSA)was determined using the area under the receiver operating characteristic(ROC)curve(AUC).Results:A total of 2310 consecutive men with PSA levels between 4.0 and 10.0 ng/mL were included,and the detection rate of PCa was 25.1%.The AUC of%fPSA and %fPSA t PSA in predicting any PCa was superior to PSA alone in men aged≥60 years(0.623 vs.0.534,p<0.0001)but not in men aged 40e59 years(0.517 vs.0.518,p=0.939).Similar result was yield in predicting HGPCa.Conclusion:In a clinical setting of Chinese men with 4.0e10.0 ng/mL PSA undergoing initial prostate biopsy,adding %fPSA to PSA can moderately improve the diagnostic accuracy for any PCa and HGPCa compared with PSA alone in patients≥60 but not in patients aged 40-59 years.

Natural orifice transluminal endoscopic surgery in urology: The Chinese experience

Objective:To describe the Chinese experience of natural orifice transluminal endoscopic surgery(NOTES)in urology.Methods:From December 2008 to May 2017,35 animal experiments and 305 clinical surgeries of NOTES or natural orifices specimen extractions(NOSE)were performed in China.The animal experiments included five kidney biopsies,24 nephrectomies and six partial nephrectomies.The clinical surgeries included 12 transvaginal NOSE(TV-NOSE),266 hybrid transvaginal NOTES(TV-NOTES)and 27 pure TV-NOTES.The TV-NOSE procedure was performed in five transumbilical laparoendoscopic single-site(U-LESS)nephrectomies,four suprapubic-assisted laparoendoscopic single-site surgery(SA-LESS)nephroureterectomies,and three laparoscopic radical cystectomies.The hybrid TV-NOTES procedure included 210 nephrectomies,31 adrenalectomies,eight nephroureterectomies,13 partial nephrectomies,and four heminephrectomies.The pure TV-NOTES procedure included five renal cyst decortications and 22 nephrectomies.Results:A total of 29 animal experiments were successfully performed.One partial nephrectomy was converted to standard laparoscopic surgery.Two kidney biopsies and two nephrectomies were unsuccessful.A total of 297 clinical surgeries were successfully performed.Six patients who underwent hybrid TV-NOTES were converted to open surgery.Two patients who underwent pure TV-NOTES were converted to SA-LESS.There were 22 major complications,16 occurred intraoperatively and six postoperatively.The mean visual analog score(VAS)of 48 h after the operation was 2.5 points in TV-NOSE,2.3 points in hybrid TV-NOTES and 1.7 points in pure TV-NOTES.The mean follow-up of 50.6(3.0-87.0)months showed that all patients were in good condition.The umbilicus scars were nearly invisible in TV-NOSE and hybrid TV-NOTES.The vaginal incision healed well.Conclusions:TV-NOSE and TV-NOTES are feasible,safe,and effective with little injury,low pain,fast recovery,and good cosmetic outcomes in properly selected patients.They are worth consideration for urological clinical practice.

Three-dimensional printing technique assisted cognitive fusion in targeted prostate biopsy

Objective:To explore the effect of 3-dimensional(3D)printing-assisted cognitive fusion on improvement of the positive rate in prostate biopsy.Methods:From August to December 2014,16 patients with suspected prostatic lesions detected by multiparametric magnetic resonance imaging(MRI)were included.Targeted prostate biopsy was performed with the use of prostate 3D reconstruction modeling,computersimulated biopsy,3D printing,and cognitive fusion biopsy.All patients had received 3.0 T multiparametric MRI before biopsy.The DICOM MRI files were imported to medical imaging processing software for 3D reconstruction modeling to generate a printable.stl file for 3D printing with use of transparent resin as raw material.We further performed a targeted 2-to 3-core biopsy at suspected lesions spotted on MRI.Results:For the 16 patients in the present study,3D modeling with cognitive fusion-based targeted biopsy was successfully performed.For a single patient,1e2 lesions(average:1.1 lesions)were discovered,followed by 2-6 cores(average:2.4 cores)added as targeted biopsy.Systematic biopsies accounted for 192 cores in total,with a positive rate of 22.4%;targeted biopsies accounted for 39 cores in total,with a positive rate of 46.2%.Among these cases,10 patients(62.5%)were diagnosed with prostate adenocarcinoma,in which seven were discovered by both systematic and targeted biopsy,one was diagnosed by systematic biopsy only,and two were diagnosed by targeted biopsy only.For systematic biopsy,Gleason score ranged from 6 to 8(average:7),while that for targeted biopsy ranged from 6 to 9(average:7.67).Among the seven patients that were diagnosed by both systematic and targeted biopsy,three(42.8%)were reported with a higher Gleason score in targeted therapy than in systematic biopsy.Conclusion:3D printing-assisted cognitive fusion technique markedly promoted positive rate in prostate biopsy,and reduced missed detection in high-risk prostate cancer.

A phase 3,double-blind,randomized placebo-controlled efficacy and safety study of abiraterone acetate in chemotherapynaı¨ve patients with mCRPC in China,Malaysia,Thailand and Russia

Objective:This double-blind,placebo-controlled phase 3 study was designed to compare efficacy and safety of abiraterone acetate+prednisone(abiraterone)to prednisone alone in chemotherapy-naı¨ve,asymptomatic or mildly symptomatic metastatic castrationresistant prostate cancer(mCRPC)patients from China,Malaysia,Thailand and Russia.Methods:Adult chemotherapy-naı¨ve patients with confirmed prostate adenocarcinoma,Eastern Cooperative Oncology Group(ECOG)performance status(PS)grade 0e1,ongoing androgen deprivation(serum testosterone<50 ng/dL)with prostate specific antigen(PSA)or radiographic progression were randomized to receive abiraterone acetate(1000 mg,QD)t prednisone(5 mg,BID)or placebo t prednisone(5 mg,BID),until disease progression,unacceptable toxicity or consent withdrawal.Primary endpoint was improvements in time to PSA progression(TTPP).Results:Totally,313 patients were randomized(abiraterone:n Z 157;prednisone:n Z 156);and baseline characteristics were balanced.At clinical cut-off(median follow-up time:3.9 months),80% patients received treatment(abiraterone:n Z 138,prednisone:n Z 112).Median time to PSA progression was not reached with abiraterone versus 3.8 months for prednisone,attaining 58%reduction in PSA progression risk(HR=0.418;p<0.0001).Abirateronetreated patients had higher confirmed PSA response rate(50%vs.21%;relative odds=2.4;p<0.0001)and were 5 times more likely to achieve radiographic response than prednisonetreated patients(22.9%vs.4.8%,p=0.0369).Median survival was not reached.Most common(≥10% abiraterone vs.prednisone-treated)adverse events:bone pain(7%vs.14%),pain in extremity(6%vs.12%),arthralgia(10%vs.8%),back pain(7%vs.11%),and hypertension(15%vs.14%).Conclusion:Interim analysis confirmed favorable benefit-to-risk ratio of abiraterone in chemotherapy-naı¨ve men with mCRPC,consistent with global study,thus supporting use of abiraterone in this patient population.

Efficacy and safety of degarelix in patients with prostate cancer:Results from a phase III study in China

Objective:To establish non-inferiority of gonadotropin-releasing hormone degarelix compared with goserelin in suppressing and maintaining castrate testosterone levels from Day 28 to Day 364 in Chinese patients with prostate cancer.Methods:This is an open-label,multi-centre study in which men aged18 years were randomised in a 1:1 ratio to once-a-month subcutaneous injection of either degarelix(240/80 mg)or goserelin(3.6 mg)for 12 months.The primary endpoint was difference in 1-year cumulative probability of suppressing testosterone to ≤0.5 ng/mL.Non-inferiority was to be established if the lower 95% confidence interval(CI)limit for difference in cumulative probability between the treatment arms was greater than -10%.Secondary endpoints included cumulative probability of prostate-specific-antigen-progression-free-survival(PSA-PFS).Safety was also assessed.Results:Baseline demographics and disease characteristics were similar between degarelix(n=142)and goserelin(n=141)treatment arms.The difference in cumulative probability of maintaining castrate levels from Day 28-364 was 3.6%(95%CI:-1.5%,8.7%),demonstrating non-inferiority of degarelix.The cumulative probability of PSA-PFS at Day 364 was higher for degarelix(82.3%,95%CI:74.7%,87.7%)versus goserelin(71.7%,95%CI:63.2%,78.5%,p=0.038).Adverse events(AEs)were similar between treatment arms,except for more injection site reactions with degarelix versus goserelin.Four(2.8%)and nine(6.4%)patients discontinued due to AEs in degarelix and goserelin groups,respectively.

Sustainable functional urethral reconstruction:Maximizing early continence recovery in robotic-assisted radical prostatectomy

Objective:To evaluate the safety profile and short-term functional outcome of sustainable functional urethral reconstruction(SFUR)in robotic-assisted radical prostatectomy(RARP).Methods:One hundred and sixty-two consecutive prostate cancer patients who underwent RARP were retrospectively analyzed,in which 53 had undergone SFUR while the other 109 had undergone conventional RARP procedures.Immediate,2-week,1-month and 3-month continence recovery and other perioperative data were compared to evaluate short-term surgical and functional outcome.Results:The median age was 68 and 67 years in the experimental group and control group,respectively(pZ0.206),with a median prostate-specific antigen(PSA)of 13.6 ng/mL(interquartile range[IQR],8.46e27.32 ng/mL)in the experimental group and 13.84 ng/mL(IQR,9.12e26.80 ng/mL)in control group(pZ0.846).Immediate,2-week,1-month and 3-month continence recovery rates between the groups were 34.0%vs.3.7%,50.9%vs.14.7%,62.3%vs.27.5%,and 79.2%vs.63.3%(all p<0.05).The morphological changes made by the new reconstruction technique were maintained on magnetic resonance imaging(MRI)3 months postoperatively.Nerve-sparing procedures and adoption of the new reconstruction technique were significantly relevant to continence recovery on logistics regression model(p<0.001).Conclusions:SFUR is a safe and easy-to-handle modification that may contribute to early continence return for RARP.Long-term follow-up and prospective studies are required to further evaluate its value in postoperative quality-of-life improvement.

Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction after failed endoscopic intervention:A technical report

Objective:Complex ureteral obstruction is refractory to conventional urological intervention.This report describes a case of laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy for treating complex ureteral obstruction.Methods:Right-side multiple ureteral stones and complicating ureteral obstruction failed an initial attempt of ureteroscopy lithotripsy with simultaneous percutaneous nephroscopy in a 23-year-old male.Laparoscopic ureterolysis with ureteroscopy and percutaneous nephroscopy was used simultaneously to dissect the periureteral adhesions with the patient placed in the Galdakao-modified supine Valdivia position.The ureter was incised to allow the insertion of a ureteral catheter through the twisted ureter,and a guide wire was advanced into the pelvis using ureteroscopy.A double-J stent was placed into the right-side ureter using antegrade percutaneous nephroscopy.Results:The laparoendoscopic procedure lasted 330 min with an estimated bleeding volume of 100 mL.The patient underwent an uneventful postoperative course,and postoperative followup radiography confirmed good positioning of the double-J stent.The double-J stent was removed 3 months after operation.The patient remained asymptomatic within a 13-month follow-up period.Conclusion:Laparoscopic ureterolysis with simultaneous ureteroscopy and percutaneous nephroscopy is an effective and safe treatment option for complex ureteral obstruction.

Global developments in prostate cancer research and clinical practice

前列腺癌症基础(PCF ) 为很快为前列腺癌症(PCa ) 发现并且发展中新药和治疗的更多作为机制承诺全球知识交换的容易世界范围的病人。为过去的 3 年， PCF 与中国前列腺癌症协会和上海 Changhai 医院合伙了在从中国和国外召集基本、翻译、临床的研究人员形成新合伙并且交换调查结果的中国主办一个会议，卓见，观点，并且向改进 PCa 的治疗的想法。前列腺疾病的第七个论坛控制了上海，在 2013 年 7 月 26-28 日，中国在 PCa 集中了于当前、新兴的开发和途径诊断，预后，和治疗，和发现并且驾驶转移和阉割抵抗的 PCa (CRPC ) 的致命的子类型的疾病机制指向。Andrology 的亚洲杂志的这个特殊版本加亮一些在论坛被介绍并且讨论的大多数紧迫的话题。

Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms(LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving symptoms that may occur due to several causes.Instead of simply focusing on the enlarged prostate,more attention has to be paid to the entire urinary tract as well as multiple system comorbidities.Therefore,prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required.Based on current literature,this paper proposes the“3Bs”concept for managing non-neurogenic male LUTS,namely,“beyond prostate”,“beyond surgery”and“beyond urology”.The clinical application of the“3Bs”enables urologists to carry out integrated,individualized and precise medical care for each non-neurogenic male LUTS patient.

Management of staghorn stones in special situations

Staghorn stones have always been a challenge for urologists,especially in some special situations,such as horseshoe kidney,ectopic kidney,paediatric kidney,and solitary kidney.The treatment of these staghorn stones must be aggressive because they can lead to renal function loss and serious complications.The gold-standard management for staghorn stones is surgical treatment with the aim of clearing the stones and preserving renal function.Treatment methods for staghorn stones have developed rapidly,such as extracorporeal shock wave lithotripsy,retrograde intrarenal surgery,percutaneous nephrolithotomy and laparoscopy and open surgery.Whether the standard procedures for staghorn stones can also apply to these stones in special situations is still not agreed upon.The decision should be made individually according to the circumstances of the patient.In this review,we evaluates the previous studies and comments on the management of staghorn stones under special situations in the hope of guiding the optimal choice for urologists.

Experience of one single surgeon with the first 500 robot-assisted laparoscopic prostatectomy cases in China's Mainland

Objectives: To summarize the experience of the first 500 robot-assisted laparoscopicradical prostatectomy (RALP) cases by one surgeon and analyze the influencing factorsof functional and oncological outcomes.Methods: Between April 2012 and October 2017, 500 patients who underwent RALP wereincluded and divided sequentially into five equal groups. Patients’ preoperative, perioperativeand postoperative outcomes were analyzed and evaluated, and the Kruskal-Wallis test wasused to analyze and compare the effect of surgeon experience by case.Results: There is a statistically significant reduction in operative time, intraoperative estimatedblood loss and postoperative hospital stay time (all p<0.001) with the increased experience.The results show that experience was the most important influencing factor in bothoperative time and blood loss. Pelvic lymph node dissection (PLND) might increase the operativetime. The total positive surgical margin (PSM) rate was 21.8%. The PSM rate in pT3 tumorswas significantly higher than that in pT2 tumors (12.0% vs. 37.1%, p<0.001). The 5-yearbiochemical recurrence (BCR)-free rate was 70.8%. The results of Cox regression showed thatpreoperative prostate-specific antigen (PSA), postoperative Gleason score (GS), and pathologicT stage were independent risk factors for BCR.Conclusion: After approximately 200 cases, the surgeon reached a plateau for RALP, but theoutcomes could still improve after more cases. The surgeon’s experience was the most importantinfluencing factor for both operative time and blood loss. PSM rate was mainly determinedby tumor stage rather than by operation experience.

CircBAGE2(hsa_circ_0061259)regulates CCND1 and PDCD10 expression by functioning as an miR-103a-3p‘sponge’to alter the proliferation and apoptosis of prostate cancer cells

Objective The aim of the article is to explore the function of circBAGE2(hsa_circ_0061259)in prostate cancer(PCa)cells.Methods Sequencing results of circBAGE2 were verified by quantitative RT PCR(qRT-PCR)and Sanger sequencing.Agarose gel electrophoresis was used to detect the resistance of GAPDH,BAGE2,and circBAGE2 to RNase R and their expression as cDNA and gDNAin 22RV1 cells.The biological functions of circBAGE2 were investigated by CCK8 assay and flow cytometry in 22RV1 cells transfected with siRNAs.Multiple databases were used to predict the target binding sites between circRNAs,miRNAs,and mRNAs.Western blotting was used to detect the expression of CCND1 and PDCD10.Results CircBAGE2 was significantly upregulated in PCa samples and PCa cells compared to that in matched normal tissues and normal cells,and CircBAGE2 knockdown inhibits cell proliferation and promotes apoptosis.Downregulation of circBAGE2 compromised the expression of CCND1 and PDCD10.The 3’UTRs of CCND1 and PDCD10 were matched by miR-103a-3p,which shared binding sites with circBAGE2.Conclusion CircBAGE2 contributes to PCa progression by upregulating CCND1 and PDCD10 expression through its role as a‘sponge’of miR-103a-3p.CircBAGE2 may be a potential therapeutic target for PCa.

全基因组关联研究发现中国人群前列腺癌两个新易感位点9q31.2和19q13.4

0前言在全球范围内，前列腺癌的发病率和病死率存在着巨大差异。该病在西方发达国家发病率最高，在非裔美国人群病死率最高，而在亚洲人群中发病率及病死率均为全球最低，提示不同人种在前列腺癌的遗传方面存在异质性。在欧美和日本人群中，全基因组关联研究（GWAS）技术已经被用于检测前列腺癌的遗传易感性位点，但至今尚无关于GWAS检测中国人群前列腺癌易感位点的报道。

Census report on Chinese urological surgeons

Objective:To grasp the general situation of Chinese urological surgeons and the status quo of their scientific research,work and training,thus providing valuable recommendations for urological talent team construction in future.Methods:The survey respondentswere the urological surgeons,who held the Certificate ofMedical Practitioner in the People’s Republic of China,whose scope of practice was confined to urological surgery.The urological surgeons involved in the project completed an online questionnaire survey.All the data were collected through the internet.Results:There were a total of 18981 urological surgeons in China in 2015,of whom 15875 from 2602 hospitals participated in this project,with a mean age of 39.64 years old.In 2015,1949631 cases of surgery were performed,including 493723 cases of open surgery,1146444 cases of endoscopic/laparoscopic surgery(robot-assisted laparoscopic surgery were excluded),6259 robot-assisted surgery and other types of urological surgery.Besides,Chinese urological surgeons published 1358 monographs as well as 14558 academic papers,and also obtained 2064 scientific funds in 2015.A total of 92122 person-time participated in academic conferences.Urological surgeons with higher educational degrees as well as higher academic titles and from Eastern China or higher-level hospitals hadmore opportunities to participate in further education and training.

The older the better:The characteristic of localized prostate cancer in Chinese men

Objective:To assess the clinicopathological features and overall survival between two groups of Chinese patients older or younger than 70 years after retropubic radical prostatectomy.Methods:From January 2001 to February 2010,390 patients receive dretropubic radical prostatectomy.After excluding 89 patients with adjuvant or neoadjuvant hormonal therapy or radiotherapy,a total of 301 patients were included in this study.We arbitrarily divided these patients into younger age group(<70 years,140 cases,46.5%)and older age group(≥70 years,161 cases,53.5%).The differences in serum prostate specific antigen(PSA),Gleason score,clinical tumor stage,and biochemical-free survival were analyzed between the two groups.Results:There were not significant differences between the two groups in high Gleason score rate and clinical tumor stage.However,older patients had significantly lower biochemical recurrence rate than those of younger patients,and had significantly higher PSA levels.Multivariate analysis showed that older age,PSA level and clinical tumor stage were significantly associated with biochemical recurrence free survival.Conclusion:In Chinese men,older age(≥70 years)is associated with better outcome.If the physical condition permits,older age alone should not exclude patients from radical prostatectomy.

Re: Experience of one single surgeon with the first 500 robot-assisted laparoscopic prostatectomy cases in China's Mainland

Robotic-assisted laparoscopic prostatectomy(RALP)has maintained an essential role in the treatment of localized prostate cancer.The so-called“trifecta”including cancer control,urinary continence,and sexual potency are three goals that surgeons need to pay close attention to.The study demonstrated that RALP for patients in Asia is safe and feasible,and the effects of RALP are at least comparable,and superior to those of open surgery or laparoscopic surgery in functional and oncologic outcomes.