Background/objectives: Prostate cancer is the most common cancer in men over 60 years of age. The development of assisted robotic surgery has improved surgical performance across several variables in dynamic ways, introducing new reconstruction techniques. The present study aims to show differences between Retzius-sparing robotic-assisted prostatectomy vs. Retzius-sparing and posterolateral fascial reconstruction in patients diagnosed with localized prostate cancer. Methods: A retrospective study was performed in a 3-year time period by a single surgeon using the Da Vinci X platform. Two groups were assessed for the study, with and without posterolateral fascial reconstruction. Demographic data were analyzed with central tendency measures, and mean differences were calculated with the Mann–Whitney test and t-test, being significant if p < 0.05. Results: A total of 199 patients were included. The posterolateral reconstruction group had 81 patients, and outcomes saw similar performances to the non-reconstruction group. Urinary continence showed a positive trend of higher percentages in the first week after surgery but had similar results after one year, with no statistically significant differences. Oncologic results and sexual dysfunction showed no statistically significant differences between groups. Conclusions: Posterolateral reconstruction combined with Retzius-sparing radical prostatectomy demonstrated improved continence and was shown to be safe, without increasing overall complications such as bleeding.

Prostate cancer (PCa) is the most common neoplasm in men. Transrectal prostate biopsy is the standard for diagnosing PCa, but it presents complications. Transperineal biopsy has gained popularity due to its better detection rates and fewer complications. To compare the efficiency and complication rates between single-access point transperineal prostate biopsy (TPPB) and transrectal prostate biopsy (TRPB) in patients with suspected PCa. Information was collected and analyzed from 241 patients with suspected PCa, divided into 2 groups: 171 in the TPPB group and 70 in the TRPB group. Pathology results were collected and complications were identified. Out of the 241 patients, 132 had positive biopsies (54.77%) and 109 negative (45.22%). TPPB was positive in 60.2%, compared to 41.4% of TRPB (p = 0.008). Complications in TPPB were hematuria (53.8%), pain (6.4%), hemospermia (6.4%), and acute urinary retention (2.3%). TPPB shown to be a protective factor for complications (odds ratio [OR] 0.028, 95% confidence interval [95% CI] 0.009-0.9; p < 0.001), compared to the TRPB technique (OR 35.5, 95% CI 10.7-117.6; p < 0.001). TPPB offers a better detection rate for PCa and it should be adopted as the first-choice method for PCa diagnosis, given that it has a lower complication rate and can be performed without the need for bowel preparation or antibiotic prophylaxis.