Intraoperative Evaluation and Management of High-Risk Prostate Cancer during Robot-Assisted Radical Prostatectomy

High-risk localized disease accounts for approximately 20–35% of newly diagnosed disease, and a number of risk stratification systems are available. After risk stratification and metastatic staging, patients are more often referred for treatment as opposed to active surveillance. There are a number of decision points important for surgical management, if selected, including the timing of surgery, further staging with MRI, discussion of extended pelvic lymph node dissection, nerve-sparing choices, and emerging concepts such as retzius-sparing approaches. We conclude with a review of oncologic and functional results specific to high-risk disease.