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The application of mixed reality navigation system in robot-assisted radical prostatectomy for high-risk prostate cancer: a propensity score‑matched cohort study

Prostate Cancer and Prostatic Diseases volume 29, pages 144–151 (2026)Cite this article

Subjects

Abstract

Background

This study aims to evaluate the efficacy and advantages of MR navigation system in robot-assisted radical prostatectomy (RARP) for high-risk prostate cancer (PCa).

Methods

We retrospectively studied 147 patients with high-risk PCa based on D’Amico risk criteria from July 2021 to November 2023. All patients chose MR-assisted RARP (MR-RARP) or standard RARP (S-RARP) after receiving comprehensive counseling on the benefits and risks of both procedures. After propensity score-matching, 57 patients were included in each group. Perioperative, functional and oncological outcomes were compared. Logistic and Cox regression models were used to identify predictors of positive surgical margin (PSM), biochemical recurrence (BCR), continence and potency recovery.

Results

The MR-RARP group had higher nerve-sparing (NS) rates (78.9% vs 54.4%, P = 0.021) and lower PSM rates (10.5% vs 26.3%, P = 0.030). Continence recovery rates were higher in the MR-RARP group at catheter removal (40.4% vs 22.8%, P = 0.044), 1 month (61.4% vs 38.6%, P = 0.015) and 3 months (73.7% vs 47.4%, P = 0.004), with no significant differences at 6 months (82.5% vs 73.7%, P = 0.258) and 12 months (93.0% vs 87.7%, P = 0.341). Furthermore, the MR-RARP group demonstrated higher potency rates at 1 month (42.1% vs 21.1%, P = 0.016) and 3 months (57.9% vs 36.8%, P = 0.024), whereas outcomes were comparable at 6 months (66.7% vs 56.1%, P = 0.248) and 12 months (77.2% vs 66.7%, P = 0.211). With a median follow-up of 28 months, BCR-free survival showed no significant differences (P = 0.295). Multivariate analyses confirmed MR navigation as an independent predictor of PSM, continence, and potency recovery (all P < 0.05). Statistical power analysis indicated a power of 0.847.

Conclusions

Real-time intraoperative MR navigation enhances surgical precision, facilitates NS techniques, and optimizes early continence and potency recovery without compromising oncological safety.

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Fig. 1: Flowchart of patient selection for the study.
Fig. 2: Flowchart of 3D MR model rendering.
Fig. 3: Real-time intraoperative navigation with MR system during RARP.

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Data availability

The data used and analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

This research was supported by the National Natural Science Foundation of China (No. 82173372 and No. 81802540), the Education Department Grant of Liaoning Province (No. LJKMZ20221138), Central Funds Guiding the Local Science and Technology Development (2024JH6/100800011), the Science and Technology Program of Liaoning Province (2021JH1/10400045), and the Bethune Urologic Oncology Special Project Research Fund (No. mnzl202023).

Author information

Author notes

  1. These authors contributed equally: Wangmin Liu, Siyu Zhou, Xueyang Yu, Yufei Yu.

Authors and Affiliations

  1. Department of Urology, The First Hospital of China Medical University, Shenyang, China

    Wangmin Liu, Siyu Zhou, Yufei Yu, Jianbin Bi & Mo Zhang

  2. Institute of Urology, China Medical University, Shenyang, China

    Wangmin Liu, Siyu Zhou, Yufei Yu, Jianbin Bi & Mo Zhang

  3. Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China

    Xueyang Yu, Meng Gao & Zhiqiang Cao

  4. Department of Urology, Benxi Central Hospital, Benxi, China

    Xueyang Yu

  5. Department of Pathology, The First Hospital of China Medical University, Shenyang, China

    Hongbo Su

  6. Department of Radiology, The First Hospital of China Medical University, Shenyang, China

    Qi Miao

  7. Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China

    Lizhu Chen

  8. Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, Shenyang, China

    Lizhu Chen

  9. Department of Urology, The Affiliated Hospital of Jiangnan University, Wuxi, China

    Jian Wang

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Contributions

WL, SZ, XY, and YY drafted the manuscript; WL, XY, and YY collected the data; SZ and MG did the data analysis; HS, QM, ZC, and JB completed the figures and tables; LC, JW, and MZ managed the article design; WL, LC, JW, and MZ reviewed the manuscript; JB and MZ provided funding support. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Lizhu Chen, Jian Wang or Mo Zhang.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Ethics Review Committee of The First Hospital of China Medical University (ethical approval No. 2024-770-2) and written informed consent was obtained from all participants. In addition, written informed consent for publication of his images was obtained from the patient in Fig. 3. All methods were conducted in accordance with the ethical guidelines of the Declaration of Helsinki and the STROCSS guidelines.

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Liu, W., Zhou, S., Yu, X. et al. The application of mixed reality navigation system in robot-assisted radical prostatectomy for high-risk prostate cancer: a propensity score‑matched cohort study. Prostate Cancer Prostatic Dis 29, 144–151 (2026). https://doi.org/10.1038/s41391-025-01003-5

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