Editor’s Note: The 2025 Pujiang Prostate Cancer Academic Congress, held from June 27–28 in Shanghai, was organized in conjunction with the Annual Meeting of the CSCO Prostate Cancer Committee (CSCO-PC), the Prostate Cancer Conference of the CACA Genitourinary Oncology Committee (CACA-GO), and the Annual Meeting of the Chinese Prostate Cancer Consortium (CPCC). Themed “Global Wisdom, Chinese Practice, and Precision Breakthroughs,” the event gathered leading experts from around the world to share the latest progress and clinical experience in prostate cancer management. In an exclusive interview with Oncology Frontier – Urology Frontier, Professor Benkang Shi from Qilu Hospital of Shandong University discussed his team’s surgical innovations and research achievements in the field of prostate cancer.01
Oncology Frontier – Urology Frontier: Could you share your perspective on the advantages and disadvantages of different surgical approaches—namely open surgery, laparoscopic surgery, and robot-assisted laparoscopic surgery—for radical prostatectomy?
Professor Benkang Shi: Radical prostatectomy has undergone three major evolutionary stages: open surgery, traditional laparoscopic surgery, and robot-assisted laparoscopic surgery.
Open surgery involves large incisions and significant trauma, with limited visual clarity and a heavy reliance on the surgeon’s tactile feedback. Due to these drawbacks—larger wounds, slower recovery—it is now rarely used.
Traditional laparoscopic surgery, performed through small abdominal incisions, offers less trauma than open procedures. The laparoscope provides a 4x magnified view, and with tools like ultrasonic scalpels, precision and hemostasis are improved. This approach has been widely adopted in surgeries for kidney, bladder, and prostate cancer. However, its limitations include a steep learning curve, limited operating field, and lack of ultra-fine maneuverability.
Robot-assisted laparoscopic surgery represents the most advanced option. It provides a 10x magnified 3D view and instruments capable of 570-degree rotation, making it highly flexible and precise—particularly valuable in tight, anatomically complex spaces. For prostate cancer, robotic surgery better preserves urinary continence and erectile nerves, reduces intraoperative bleeding, and improves postoperative recovery of urinary and sexual function, thus significantly enhancing quality of life.
02
Oncology Frontier – Urology Frontier: As robotic surgery becomes increasingly mature in prostate cancer treatment, could you elaborate on your team’s experience and achievements in this area?
Professor Benkang Shi: Our team has accumulated extensive experience in robotic-assisted surgery and integrated advanced imaging technologies—such as PSMA PET/CT—into our surgical planning. This allows for more accurate staging and lymph node mapping, improving the precision of lymphadenectomy.
For patients with complex surgical histories, including multiple prior abdominal operations where traditional laparoscopy is challenging, we have adopted alternative approaches such as the transvesical or perineal routes under robotic guidance. This has expanded surgical indications. For instance, in elderly patients with a history of hernia mesh repairs, we’ve utilized a posterior approach for radical prostatectomy to avoid the limitations of anterior access.
In cases of locally advanced prostate cancer, we developed a novel “W-shaped” urethral reconstruction technique. This method reconstructs the external urethral sphincter, levator ani muscle, median dorsal raphe (MDR), and Denonvilliers’ fascia, significantly improving postoperative continence. These results have been published in the World Journal of Urology, and we are currently conducting a national multicenter clinical study to further validate this technique and provide improved surgical options for Chinese patients.
03
Oncology Frontier – Urology Frontier: After radical prostatectomy, how do you tailor PSA monitoring and imaging follow-up based on pathological features and molecular subtypes?
Professor Benkang Shi: Postoperative follow-up should be personalized based on pathological features and molecular classification. Our research has shown that the TP53 mutation rate in Chinese patients with hormone-sensitive prostate cancer is as high as 23%. These patients tend to respond poorly to traditional endocrine therapy and often require combined modalities, such as chemotherapy and radiotherapy.
For patients with neuroendocrine differentiation, BRCA mutations, intraductal carcinoma, and other special pathological subtypes, we introduce novel agents during the adjuvant phase—or even use neoadjuvant therapy—to achieve more precise, individualized disease management.
We also emphasize the importance of dynamic PSA monitoring and imaging surveillance. Follow-up strategies are tailored to each patient’s pathological risk and molecular profile to ensure early detection of recurrence or metastasis. This approach enables timely treatment adjustments, ultimately improving long-term survival and quality of life.
