Hindawi Publishing Corporation Prostate Cancer Volume 2011, Article ID 878323, 6 pages doi:10.1155/2011/878323 Clinical Study A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a Single Surgeon Series Moben Mirza, 1 Kevin Art, 1 Logan Wineland, 2 Ossama Tawfik, 3 and J. Brantley Thrasher 1 1 Department of Urology-MS 3016, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA 2 University of Kansas School of Medicine, Kansas City, KS 66160, USA 3 Department of Pathology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA Correspondence should be addressed to Moben Mirza, mmirza@kumc.edu Received 30 June 2010; Accepted 4 October 2010 Academic Editor: Katsuto Shinohara Copyright © 2011 Moben Mirza et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP. 1. Introduction Radical prostatectomy remains the most commonly used treatment for clinically localized prostate cancer and can be performed by a variety of techniques. First performed by Young in 1904, the radical perineal prostatectomy (RPP) has been a proven technique for over 100 years. However, in the early 1980s, modifications to the radical retropubic prostatectomy (RRP) were introduced. RRP became the most popular surgical option and gained wider acceptance with the introduction of the nerve sparing technique by Walsh [1]. Large series comparing RRP with RPP have generally shown similar outcomes, except decreased blood loss associated with RPP [2, 3]. In more recent years, robot- assisted laparoscopic prostatectomy (RALP) and laparo- scopic radical prostatectomy (LRP) have been introduced as minimally invasive techniques with associated benefits of shorter recovery periods, decreased postoperative pain, and smaller incisions [4]. There are multiple studies which have compared surgical outcomes between the different techniques including rates of positive surgical margin (PSM) among the different surgical modalities. Several studies have shown decreased PSM rates with RALP compared to RRP, yet others have demonstrated no advantage when RALP is used [5–8]. Regardless of their findings, these studies many times have inherent limitations introduced when data from multiple surgeons is compiled. This also creates potential bias in patient selection between the different surgical modalities which may impact results. Also, the popularity of RPP has been cyclical in nature since the introduction of RRP and RALP [2], a trend which may further complicate direct comparisons of the techniques. Although its effectiveness compared to RRP has been demonstrated, there is a paucity of data comparing RPP to RALP. In addition, there is lack of data comparing QOL outcomes between these groups. The purpose of our study was to evaluate the incidence and location of PSM among RPP, RRP, and RALP in 463 consecutive patients performed