Prostate cancer is among the most common malignancies affecting elderly men. Early detection, accurate staging, and appropriate surgical intervention are crucial for favorable outcomes. We report a case of locally advanced prostate adenocarcinoma managed successfully with retzius-sparing robotic-assisted radical prostatectomy.

A 76-year-old male presented with an elevated prostate-specific antigen (PSA) level of 17 ng/mL on December 5, 2023. Prostate biopsy performed on December 27, 2023, confirmed prostate adenocarcinoma (Gleason score 3+4=7). Imaging studies, including pelvic MRI (January 9, 2024) and bone scan (January 8, 2024), indicated clinical stage cT3aN0M0 with extracapsular extension but no lymph node or distant metastases. The patient underwent retzius-sparing robotic-assisted radical prostatectomy with extended pelvic lymph node dissection on January 31, 2024.

The postoperative recovery was uncomplicated, and the patient was discharged seven days postoperatively. He achieved complete urinary continence at one and a half months following surgery. Follow-up evaluation at three months postoperatively revealed an undetectable PSA level (<0.025 ng/mL), indicating an excellent biochemical response.

Retzius-sparing robotic-assisted radical prostatectomy with extended pelvic lymph node dissection provided effective management of locally advanced prostate adenocarcinoma (cT3aN0M0) with excellent functional and oncological outcomes, including rapid continence recovery and favorable PSA response.