Introdução: A prostatectomia radical é uma forma definitiva de tratamento do câncer localizado da próstata. Aproximadamente 40% dos pacientes tratados pela prostatectomia radical apresentaram progressão da doença, mesmo com a doença confinada ao órgão. Acurácia previsão do risco de recorrência é útil para se considerar uma terapia adjuvante ou alguma forma de tratamento investigacional. Observa-se, atualmente, que fatores anatomopatológicos e clínicos são insuficientes para o estadiamento preciso do câncer da próstata. Alguns estudos têm ressaltado a influência dos processos de adesão celular como pré-requisitos para invasão tumoral e metástase, sendo as moléculas CD44 e a família Ezrin-Radixin-Moesin (ERM), citadas como facilitadoras destes processos. Objetivos: Avaliar a expressão do complexo protéico CD44/ERM, no câncer da próstata, bem como sua associação com os fatores prognósticos e sobrevida nesta neoplasia. Material e Métodos: Foram analisados retrospectivamente os blocos de parafina de 100 pacientes, portadores de câncer localizado da próstata comprovado por biópsia transretal da próstata, submetidos à prostatectomia radical, no período de 1995 a 2000, do Departamento de Anatomia Patológica do Hospital Geral de Fortaleza e Laboratório Biopse. As lâminas de todos os casos selecionados para este estudo foram coradas com hematoxilina e eosina e revisadas. A preparação das lâminas foi feita pela técnica de Tissue Microarray. A análise imunohistoquímica foi realizada, utilizado-se para controle positivo um tecido sabidamente com expressão da proteína a ser pesquisada. Foram realizadas duas lâminas de controle negativo. A primeira delas foi feita com a retirada do anticorpo primário e substituição por soro bovino fetal. O segundo controle negativo foi realizado com a retirada da reação do anticorpo secundário e substituição por soro contendo imunoglobulina do mesmo idiotipo do anticorpo primário, mas da mesma espécie. Os dados obtidos foram avaliados através do Teste do Qui-quadrado ou do Teste Exato de Fisher. Foram elaboradas curvas de sobrevivências, segundo o método de Kaplan-Meier. Curvas de sobrevivência foram comparadas através do Teste Log-Rank. Resultados: Os níveis de expressão imunohistoquímica de Ezrin,Radixin, Moezin e CD44V6 no câncer da próstata, foram respectivamente 48,8%, 16,3%, 20,9% e 70,9%. Houve uma diminuição da expressão do Radixin e Moesin quando comparados com os valores de PSA pré-operatório. Esta diminuição da expressão foi estatisticamente significante (p< 0,008 e p< 0,044) para os pacientes portadores de PSA> 10ng/ml no pré-operatório. A expressão do Ezrin teve significância estatística com relação à redução global da sobrevida dos pacientes quando comparado com as outras proteínas de adesão. Conclusão: A expressão da proteína Ezrin no câncer da próstata parece ser fator prognóstico independente na redução da sobrevida global, podendo vir a ser um importante marcador molecular em câncer da próstata / Introduction: Radical prostatectomy is one form of definite treatment of clinically localized prostate cancer. Approximately 40% of the patients treated by radical prostatectomy presented disease progression, even with the disease confined to the organ. Predictive accuracy of the risk of recurrence is useful to be considered as an adjuvant therapy or in some form of investigational treatment. To date, anatomopathological and clinical factors are observed as insufficient for the precise staging of prostate cancer. Some studies have emphasized the influence of cellular adhesion processes as a prerequisite for tumor invasion and metastasis, with the molecules CD44 and the ERM (Ezrin/Radixin/Moesin) family cited as facilitators of these processes. Objectives: To evaluate the expression of CD44/ERM complex protein in prostate cancer, as well as its association with prognostic and survival factors in this neoplasm. Material and Methods: Retrospectively analyzed were the paraffin blocks of 100 prostate cancer patients, proven by transrectal ultrasound-guided prostate biopsy, submitted to radical prostatectomy in the period from 1995 to 2000 at the Department of Pathological Anatomy of the General Hospital of Fortaleza and a private laboratory (Fortaleza, Brazil). The slides of all cases selected for this study were stained with hematoxylin and eosin and reviewed. The preparation of the slides was done by tissue microarray technique. Immunohistochemical analysis was carried out using a tissue known to have expression to the protein being studied as positive control. Two slides of negative control were prepared. The first slide was prepared with the omission of the primary antibody and substitution by fetal bovine serum. The second negative control was prepared with the omission of the secondary antibody response and substitution by serum containing immunoglobulin of the same idiotype of the primary antibody, but of the same species. The obtained data were evaluated through chi-square test or Fishers exact test. Survival curves were prepared following the Kaplan-Meier method. Survival curves were compared by the log-rank test. Results: The immunohistochemical expression levels of Ezrin, Radixin, Moezin and CD44V6 in prostate cancer were respectively 48.8%, 16.3%, 20.9% and 70.9%. There was a reduction of Radixin and Moesin expression when compared with preoperative PSA values. This reduction of expression was statistically significant (p <0.008 and p <0.044) for the patients with preoperative PSA> 10ng/ml. Ezrin expression had statistical significance in relation to reduction of overall patient survival when compared with other adhesion proteins. Conclusion: Ezrin protein expression in prostate cancer seems to be an independent prognostic factor in the reduction of overall survival, being able to become an important molecular marker in prostate cancer

Introdução: A prostatectomia perineal tem sido proposta como um procedimento seguro e pouco invasivo, sem comprometer os princípios oncológicos. No entanto, este acesso tem sido questionado sobre o risco de promover a incontinência anal. Objetivo: avaliar os efeitos do acesso para a prostatectomia perineal no mecanismo de continência anal. Métodos: Trinta e um pacientes com indicação cirúrgica de prostatectomia perineal foram avaliados entre agosto de 2008 e maio de 2009. Dados do pré e pós operatório (8 meses): estadiamento do câncer de próstata, a avaliação clínica (Índice de incontinência anal da Cleveland Clinic - CCISS), índice de qualidade de vida na incontinência anal (FIQL) e manometria anorretal. Os parâmetros médios manométricos foram: pressão de repouso (RP / mmHg), pressão de contração voluntária máxima (MSP / mmHg), zona de alta pressão (ZAP / cm), índice de fadiga do esfíncter (SFI / min.), índice de assimetria esfincteriana (SAI /%), limiar de sensibilidade retal (RST / ml) e volume retal máximo tolerado (MTRV / ml). Resultados: Foi concluída a avaliação em vinte e três pacientes, com média de idade de 65 (54-72) anos. Pré-operatório: o peso médio da próstata foi de 34,5 (24-54) gramas, Gleason intervalo de valor da pontuação 06/07. Os valores médios pré e pós-operatório da CCISS foram 0,9 ± 1,9 e 0,7 ± 1,2 (p> 0,05) e não houve uma mudança significativa no valor FIQL. Os valores médios pré e pós operatório de parâmetros manométricos foram, respectivamente: RP: 64 ± 23 e 65 ± 17, SP: 130 ± 41 e 117 ± 40, ZAP: 3,0 ± 0,9 e 2,7 ± 0,8, SFI: 3,0 ± 2,1 ± 11 e 5.4, RST: 76 ± 25 e 71 ± 35, MTRV 157 ± 48 e 156 ± 56, e SAI: 22,4 ± 9 e 14,4 ± 5, sendo o SAI o único parâmetro com mudança estatisticamente significativa (p: 0, 003). Conclusão: O acesso perineal para prostatectomia não afetou os parâmetros de continência anal. Houve, no entanto melhora na simetria esfincteriana / Introduction: Perineal prostatectomy has been proposed as a less invasive and a safer procedure, without compromise of oncological principles. However, this access has been questioned about the risk of promoting anal incontinence. Purpose: this study aimed to evaluate the effects of perineal access for prostatectomy in continence mechanism. Methods: Thirty one patients with surgical indication for perineal prostatectomy were evaluated between August 2008 and May 2009. Preoperative and postoperative (8 months) data included: prostate cancer staging, clinical evaluation (Cleveland Clinic anal incontinence score system - CCISS), Fecal incontinence quality of life score (FIQL) and anal manometry. Mean manometric parameter were: resting pressure (RP/mmHg), maximal squeeze pressure (MSP/mmHg), high pressure zone (HPZ/cm), sphincter fatigue index (SFI/min), sphincter asymmetry index (SAI/%), rectal sensory threshold (RST/ml) and maximum tolerated rectal volume (MTRV/ml). Results: Twenty three patients, mean age 65 (54-72) years, completed evaluation. Preoperative: prostate weight was 34.5 (24-54) grams, Gleason score value range 6 /7. Mean pre and postoperative values of CCISS were 0.9±1.9 and 0.7±1.2 (p>0.05) and there was not a significant change in FIQLS value. The mean preoperative and postoperative values of manometric parameters were, respectively: RP: 64±23 and 65±17, SP: 130±41 and 117±40, HPZ: 3.0±0.9 and 2.7±0.8, SFI: 3.0±11and 2.1 ±5.4, RST: 76±25 and 71±35, MTRV 157±48 and 156±56, and SAI: 22.4±9 and 14.4±5. Significant statistics change only in the SAI (p=0,003). Conclusion: The perineal prostatectomy did not affect anal continence parameters

Robotassisterad prostatektomi innebär speciella omständigheter för patienten avseende positionering där de ligger i ett extremt så kallat Trendelenburgläge med huvudet sänkt 45 grader samt att buken blåses upp med koldioxid. Dessa två faktorer predisponerar för att patienten drabbas av postoperativt illamående och kräkningar. Syftet med studien var att undersöka förekomsten av postoperativt illamående och kräkningar 24 timmar efter robotassisterad prostatektomi. Patienterna själva skattade sitt illamående enligt MANE- skalan som är en 7-punktsskala. Metoden som användes är en kvantitativ icke experimentell pilotstudie. 20 patienter deltog i studien. Resultatet visade att mer än en tredjedel av patienterna drabbades av postoperativt illamående och/eller kräkning inom 24 timmar efter operationsslut. Av samtliga 20 deltagare hade enbart en patient erhållit antiemetika i förebyggande syfte. Slutsatsen för denna studie var att man bör gå vidare och undersöka fler patienter för att se om behov finns för att eventuellt justera antiemetikaprofylax för denna patientgrupp i framtiden. / Robotic assisted prostatectomy requires special circumstances for the patient regarding their positioning. They lay with the head tilted down 45 degrees in a position called Trendelenburg and their bowel is insufflated with carbon dioxide which both can cause nausea and vomiting. The aim of this study was to investigate the frequency of postoperative nausea and vomiting 24 hours after a robotic assisted prostatectomy. The patients valued their own nausea according to the MANE-scale which is a 7-pointed scale. The method used was a quantitative non- experimental pilot study. 20 patients participated in the study. The result showed that more than a third of the patients were nauseas or vomited within 24 hours after surgery. Of all 20 participants only one had received antiemetics in preventing purpose. The conclusion was that this study should be proceeded and a larger number of patients should be evaluated too see if there is a need to adjust the antiemethic prophylaxis for this patientgroup in the future.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Purpose: The aim of this study was to explore the African American prostate cancer survivorship experience following radical prostatectomy and factors contributing to quality of life during survival. Design: African American men who were part of a larger prostate cancer cohort were invited to participate in a focus group. Eighteen open-ended questions were designed by the study team and an experienced moderator to elicit participants' survivorship experiences. Results: Twelve men consented to participate in the study. Emergent themes included views of prostate cancer in the African American community, perceptions of normalcy, emotional side effects following radical prostatectomy, and social support involvement and impact during recovery. Conclusions: Previous findings suggest that African American men may experience more distress than Caucasian men when facing typical prostate cancer side effects. Traditional masculine role norms and negative perceptions of “disease disclosure” in the African American community could be contributing to the distress reported by some in this study. Strengthening social support systems by promoting more prosocial coping and help-seeking behaviors early in the survivorship journey may help bypass the detrimental health effects associated with masculine role identification, resulting in improved quality of life throughout the lengthy survival period anticipated for these men.

The purpose of this narrative review is to describe the different nerve-sparing techniques applied during radical prostatectomy and document their functional impact on postoperative outcomes. We performed a PubMed search of the literature using the keywords “nerve-sparing”, “techniques”, “prostatectomy” and “outcomes”. Other potentially eligible studies were retrieved using the reference list of the included studies. Nerve-sparing techniques can be distinguished based on the fascial planes of dissection (intrafascial, interfascial or extrafascial), the direction of dissection (retrograde or antegrade), the timing of the neurovascular bundle dissection off the prostate (early vs. late release), the use of cautery, the application of traction and the number of the neurovascular bundles which are preserved. Despite this rough categorisation, many techniques have been developed which cannot be integrated in one of the categories described above. Moreover, emerging technologies have entered the nerve-sparing field, making its future even more promising. Bilateral nerve-sparing of maximal extent, athermal dissection of the neurovascular bundles with avoidance of traction and utilization of the correct planes remain the basic principles for achieving optimum functional outcomes. Given that potency and continence outcomes after radical prostatectomy are multifactorial endpoints in addition to the difficulty in their postoperative assessment and the well-documented discrepancy existing in their definition, safe conclusions about the superiority of one technique over the other cannot be easily drawn. Further studies, comparing the different nerve-sparing techniques, are necessary.

Bakgrund: Radikal prostatektomi är en onkologisk botande behandlingsmetod mot lokaliserad prostatacancer. Komplikationer till ingreppet är bland annat sexuell dysfunktion vilket påverkar patienterna negativt. Syfte: Syftet var att belysa patienters upplevelser av sexuell dysfunktion efter radikal prostatektomi. Metod: Studien genomfördes som en allmän litteraturstudie med induktiv ansats där 11 resultatartiklar ur databaserna PubMed, CINAHL och PsycINFO inkluderades. För att besvara syftet på studien bearbetades artiklarnas innehåll och sammanställdes i flera steg. Resultat:Sexuell dysfunktion var något nästan alla patienter upplevde. Den sexuella dysfunktionen orsakade negativ självkänsla och upplevelse av minskad maskulinitet. Patienter upplevde att den sexuella dysfunktionen blev värre i samband med brist på information om komplikationer postoperativt. Patienter kunde i viss utsträckning få sexuell återhämtning med hjälp av medicinering mot erektil dysfunktion. En god partnerrelation var ett viktigt emotionellt stöd postoperativt. Sexuell dysfunktion påverkade relationer både positivt och negativt. Konklusion: Patienterna påverkades negativt av sexuell dysfunktion. Information om komplikationerna var viktigt för att öka återhämtning och minska lidande. Studien var värdefull för att sjuksköterskor ska ha möjligheten att bättre vårda patienter som genomgått en radikal prostatektomi. / Background: Radical prostatectomy is an oncological curative treatment method for localized prostate cancer. Complications of the procedure include sexual dysfunction, which negatively affects patients. Objective:The aim was to illuminate patients' experiences of sexual dysfunction after radical prostatectomy. Method: The study was conducted as a literature review with an inductive approach, including 11 research articles from the databases PubMed, CINAHL, and PsycINFO. To answer the purpose of the study, the content of the articles was processed and compiled in several steps. Results: Almost all patients experienced sexual dysfunction which caused them to experience negative self-esteem and self- perceived masculinity. Patients described that the sexual dysfunction worsened in connection with the lack of information about postoperative complications. Patients could to some extent achieve sexual recovery with medication for erectile dysfunction. A good partner relationship was an important emotional support postoperatively. Sexual dysfunction affected relationshipsboth positively and negatively. Conclusion: Patients was negatively affected by sexual dysfunction. Information about complications is crucial to enhance recovery and reduce suffering. The study was valuable for nurses to provide better care for patients who has underwent radical prostatectomy.

Bakgrund: Prostata är en körtel som befinner sig under mäns urinblåsa och omger urinröret. Prostatacancer är den vanligaste cancerform i Sverige bland män. En vanlig behandling är radikal prostatektomi vilket innebär avlägsnade av prostatakörtel. En av biverkningar vid denna behandling är erektil dysfunktion som påverkar över hälften av män efter ingreppet. Mäns sexualitet är intimt kopplad till det sociala sammanhanget och kan påverkas av både fysiologiska och psykosociala faktorer. Syfte: Att beskriva mäns upplevelse av sexualitet efter radikal prostatektomi. Metod: Det valdes meta-etnografi som analysmetod för att besvara metasyntesens syfte. För datainsamling användes PubMed, CINAHL och PsykINFO.Kvaliteten av artiklarna bedömdes enligt Joanna Briggs granskningsmall. Metasyntesens resultat grundas på 15 vetenskapliga artiklar. Resultat: Resultatet utgörs av tre huvudkategorier som framkom under analysen av artiklarna: Första huvudkategori är Upplevelsen av det sexuella livet, vilken inkluderar underkategorin Brist på stöd och underkategorin Begränsningar för sexuell aktivitet. Den andra huvudkategorin är Påverkan på psykosocialt välbefinnande och upplevda känslor som följs av underkategorin Livsövergångar och förändringar, påverkan på livskvalitet och underkategorin Omdefiniering av sexualitet. Den tredje huvudkategori är Förändrad identitet som följs av underkategorin Förlorad av självförtroende, maskulinitet och manlighet. Slutsats: Män upplevde negativa förändringar i sina sexuella skript, påverkade av traditionella maskulinitetsnormer. Av den anledningen är det av stor betydelse att denna patientgrupp får adekvat stöd efter operationen och sexuell rådgivning i syfte att främja sexuell hälsa, sexualitet och att minimera negativa biverkningar på livskvalitet och mäns uppfattning av maskulinitet samt manlighet. Klinisk tillämpbarhet: Denna studie kan bidra till en ökad insikt, kunskap och förståelse om män som har genomgått radikal prostatektomi. Vilket vidare kan hjälpa barnmorskor att hantera bemötandet av dessa patienter. Förbättrad insikt och förståelse för problematiken kan främja högkvalitativ personcentrerad vård, minska sjukhusvistelse och öka patienternas tillit för hälso- och sjukvården. / Background: The prostate is a gland located under the male bladder and surrounding the urethra. Prostate cancer is the most common form of cancer in Sweden among men. A common treatment is radical prostatectomy, which means removal of the prostate gland. One of the side effects of this treatment is erectile dysfunction, which affects over half of men after the procedure. Men's sexuality is intimately linked to the social context and can be influenced by both physiological and psychosocial factors Aim: To describe men's experience of sexuality after radical prostatectomy. Method: Meta-ethnography was chosen as the analysis method to answer the purpose of the meta-synthesis. PubMed, CINAHL and PsykINFO were used for data collection. The quality of the articles was assessed according to the Joanna Briggs review template. The results of the meta-synthesis are based on 15 scientific articles. Results: The result consists of three main categories that emerged during the analysis of the articles: The first main category is the experience of sexual life, which includes the subcategory Lack of support and the subcategory Restrictions on sexual activity. The second main category is Impact on psychosocial well-being and perceived emotions followed by the sub-category Life transitions and changes, impact on quality of life and the sub-category Redefining sexuality. The third main category is Changed Identity which is followed by the sub-category Loss of Confidence, Masculinity and Masculinity. Conclusion: Men experienced negative changes in their sexual scripts, influenced by traditional masculinity norms. For that reason, it is of great importance that this patient group receives adequate support after the operation and sexual counseling in order to promote sexual health, sexuality and to minimize negative side effects on quality of life and men's perception of masculinity and masculinity. Clinical applicability: This study may contribute to an increased insight, knowledge and understanding of men who have undergone radical prostatectomy. Which can further help midwives manage the treatment of these patients. Improved insight and understanding of the problem can promote high-quality person-centred care, reduce hospital stays and increase patients' trust in health care.

Radical prostatectomy is the main surgical treatment for prostate cancer and is associated with various short-term complications. Racial and ethnic minority patients have worse postoperative outcomes than White patients following prostate cancer surgery. One of the factors that may contribute to the racial differences in postoperative outcomes is the differential use of new medical technology of robot-assisted surgery (RAS) across racial and ethnic groups. Patients undergoing robot-assisted radical prostatectomy (RARP) have been shown to have reduced short-term complications, length of stay (LOS), and readmissions and comparable long-term survival compared with patients undergoing open radical prostatectomy (ORP). Previous studies demonstrated that racial and ethnic minority patients with prostate cancer were less likely to receive RARP than White patients. However, critical gaps remain in 1) understanding current evidence on racial and ethnic disparities related to RAS in pelvic cancer surgery thoroughly; 2) determining the impact of RARP on racial and ethnic disparities in postoperative outcomes among prostate cancer patients, and; 3) investigating the role of surgeons on the differential use of RARP across racial and ethnic groups. To address these gaps, this dissertation conducted a systematic review to comprehensively understand racial and ethnic disparities in the use of RAS in four major pelvic cancer treatments (prostate, uterine, bladder, and rectal cancers). Following the systematic review, empirical analyses were performed using linked New York State Cancer Registry and statewide discharge records to determine the contribution of RARP to racial and ethnic disparities in the short-term outcomes after prostate cancer surgery, including determining the presence and pattern of interaction between race/ethnicity and RARP use. Based on a multilevel framework, two important hypotheses were also tested to assess surgeons’ influence on the use of RARP across racial and ethnic groups through access to care and the process of care. The systematic review found consistent evidence that Black and Hispanic patients were less likely to receive RAS than White patients in all four pelvic cancer surgeries. There is a lack of formal assessment to determine the impact of RAS use on racial and ethnic disparities in postoperative outcomes. The systematic review also found that racial and ethnic minorities were less likely to receive treatment at RAS-performing or high-technology centers than White patients. But there is a paucity of research examining physician-level factors that may be related to differential use of RAS across racial and ethnic groups. The first empirical analysis detected a statistical interaction between race/ethnicity and procedure approach that was present on the additive scale but not on the multiplicative scale. Specifically, when undergoing RARP rather than ORP, non-Hispanic Black (NHB) and Hispanic men with prostate cancer, as compared to non-Hispanic White (NHW) men, experienced a greater reduction in the risk of adverse short-term outcomes of major events (NHB vs. NHW: RERI -0.32, 95% CI (-0.70,-0.01); Hispanic vs. NHW: RERI -0.28, 95% CI (-0.74,0.09)) and prolonged LOS (NHB vs. NHW: RERI -0.32, 95% CI (-0.70,-0.01); Hispanic vs. NHW: RERI -0.28, 95% CI(-0.74,0.09)) on the absolute risk (additive) scale. The second empirical analysis confirmed the two hypotheses related to surgeons’ role in the racial and ethnic disparities related to RARP use. First, NHB and Hispanic patients were more likely to be treated by surgeons who were low-RARP users (NHB vs. NHW: OR 1.73, 95% CI 1.58-1.90; Hispanic vs. NHW: OR 2.14, 95% CI 1.90-2.41) or by surgeons at non-RARP facilities (NHB vs. NHW: OR 4.26, 95% CI 3.45-5.27; Hispanic vs. NHW: OR 4.01, 95% CI 3.44-4.67) than NHW patients, supporting racial and ethnic disparities in access to care. Second, when treated by the same surgeon and having similar conditions, NHB and Hispanic patients were less likely to receive RARP than NHW patients (NHB vs. NHW: OR 0.73, 95% CI 0.59-0.91; Hispanic vs. NHW: OR 0.72, 95% CI 0.55-0.96), supporting racial and ethnic disparities in the process of care. In summary, this dissertation identified gaps in current literature and showed that NHB and Hispanic patients with prostate cancer were less likely to receive but benefitted more from RARP than NHW patients. Increasing equitable penetration of robot-assisted technology may help reduce racial disparities in patient outcomes after radical prostatectomy. This dissertation also revealed that NHB and Hispanic patients were less likely to be treated by high-RARP-use surgeons and less likely to receive RAPR when treated for similar conditions by the same surgeons than NHW patients. Addressing structural barriers faced by racial and ethnic minority patients during care-seeking and the process of care can help reduce disparities in RAS use.

INTRODUÇÃO: O câncer de próstata é responsável por 15% dos casos novos de câncer que acometem os homens e pela 5ª causa de morte. As técnicas minimamente invasivas, sobretudo a cirurgia robótica tornou-se a técnica comumente empregada nos Estados Unidos. Muitos artigos tentam demonstrar a curva de aprendizado necessária para a estabilização dos resultados, mas a implementação de novas tecnologias passa por diversos desafios, além da avaliação de seus resultados e dos custos, o que em países em desenvolvimento pode ter um importante impacto no sistema de saúde. OBJETIVO: Avaliar a curva de aprendizado da prostatectomia radical laparoscópica robótica assistida (PRRA) para o tratamento do câncer de próstata, de acordo com a continência urinária, a potência sexual, o tempo cirúrgico e o controle oncológico. MÉTODOS: Duzentos pacientes com neoplasia de próstata localizada submetidos à PRRA por um único cirurgião foram divididos em quatro grupos de acordo com a sequência das cirurgias. Foram avaliados os dados intra-operatórios, como: tempo cirúrgico, perda sanguínea estimada e as margens cirúrgicas. Também durante o pósoperatório foram avaliadas a potência (IIEF) e a continência (ICIQ). RESULTADOS: Os pacientes apresentaram idade média de 60,6 anos (59,72-61,61), volume prostático ao toque retal de 40 gramas e valor do PSA 6,95 ng/ml (5,79-8,10) semelhantes em todos os grupos (p > 0,05). A biópsia prostática pré-operatória mostrou diferença no escore de Gleason e no tamanho da próstata, sendo que o escore 6 foi menos frequente no grupo 4, representado por 23 pacientes (46%) e no grupo 1, com 39 pacientes (78%) (p < 0,01). Já o tamanho prostático avaliado pelo USTR foi de 39,6 gramas (29,75-48,7) no grupo 4 e 30,5 gramas (23,0-38,15) no grupo 2. A curva de aprendizado estabelecida demonstrou uma diminuição no tempo cirúrgico de 157 minutos (145-170) no grupo 1, para 132 minutos (119-140) no grupo 2 (p < 0,01). A perda sanguínea estimada também se reduziu aproximadamente pela metade: de 395 ml (250-500) no grupo 1, para 200 ml (150-250) no grupo 3 (p < 0,01). As margens positivas reduziram de 16% para apenas 8%, mas se mostraram estatisticamente semelhantes (p=0,236). A capacidade de penetração com doze meses praticamente dobrou de 38% (19 pacientes) no grupo 1 para 80% (40 pacientes) no grupo 4 (p=0,003). A continência avaliada com um ano mostrou-se melhor no grupo 4 (98%) quando comparado aos pacientes do grupo 1 (94%) (p=0,001). As complicações foram estatisticamente semelhantes entre os quatro grupos (p = 0,668). A análise da recidiva bioquímica não demonstrou diferença (p > 0,05). CONCLUSÕES: A curva de aprendizado da PRRA é variável de acordo com o parâmetro a ser avaliado, e apesar do equipamento e da tecnologia, à medida que se aumenta a experiência do cirurgião, melhores resultados são obtidos. O tempo de cirurgia e o sangramento estabilizaram-se, respectivamente, após 50 e 100 PRRA. A potência e a continência, por sua vez, estabilizaram-se após 150 PRRA. É importante ressaltar que o controle oncológico necessita de um período de acompanhamento mais longo para ser avaliado / BACKGROUND: Prostate cancer is responsible for 15% of new cases of male cancer and is the fifth leading cause of death. Minimally invasive and mainly, robotic surgery technique became the technique most widely utilized in the United States. Many articles have tried to demonstrate the required learning curve to achieve the plateau. Although, new techniques implementation go through many challenges besides the evaluation of its results, costs also became an issue, which may impact in developing countries health system. OBJECTIVE: We aim to evaluate the learning curve of robot-assisted radical prostatectomy (RARP) for the treatment of prostate cancer, according to continence, potency, surgical time and oncologic control. METHODS: Two hundred patients with localized prostate cancer that underwent RARP by a single surgeon were divided into four groups according to its surgical sequence. Intraoperative data, such as surgical time, estimated blood loss and margins were recorded. Also postoperative functional parameters as continence and potency were gathered using validated questionnaires (ICIQ and IIEF). RESULTS: Patients mean age were 60.6 years (59.72- 61.61), mean prostate volume at digital rectal examination was 40 grams and PSA value 6.95 ng/ml (5.79-8.10) were similar in all groups (p > 0.05). Pre-operative prostate biopsy showed difference in Gleason score and prostate size. Gleason score 6 was less frequent in group 4, 23 patients (46%), than group 1, 39 patients (78%)(p <0.01) and prostate size at TRUS was 39.6 grams (29.75- 48.7) in group 4 and 30.5 grams (23.0- 38.15) in group 2. The established learning curve showed a reduction on surgical time from 157 minutes (145-170) in group 1 to 132 minutes (119-140 min) in group 2 (p < 0.01). The estimated blood loss also decreased almost to half, from 395 ml (250-500) in group 1 to 200 ml (150-250) in group 3 (p < 0.01). Positive margins decreased from 16% to only 8 %, but were statistically similar (p=0.236). Nineteen patients (38%) could have sexual intercourse at an year after the surgery, in the first group but latest, in the fouth group, it doubled to 40 patients (80%) (p=0.003). Also continence improved in group 4(98%) when compared with group 1 (94%) (p=0.001). Complications were similar between groups (p=0.668). Biochemical recurrence also showed no difference (p > 0.05). CONCLUSIONS: Therefore, the learning curve of the RARP is variable according to the evaluated parameter and obviously, despite the equipment and technology, the increase of surgical experience the best the outcome. Surgery time plateau were achieved at 50 RARP, estimated blood loss stabilized after 100 surgeries, sexual function and urinary continence after 150 RARP. Cancer control requires a longer follow-up period for review