Prostate surgery outcomes show little difference between techniques

Kathleen Blanchard's picture
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A new review shows that outcomes using laparoscopic surgery for prostate cancer (LRP), with or without robotic assistance, is not necessarily better than the standard open radical prostatectomy procedure (ORP). Overall mortality and morbidity outcomes are the same between open radical prostatectomy and laparoscopic radical prostatectomy.

Each year 200,000 men are diagnosed with prostate cancer and one third will undergo surgery. The new review shows there are few differences between surgery technique used, and that men should be informed of the risks and benefits between open radical prostatectomy and laparoscopic radical prostatectomy, with or without robotic assistance.

Researchers from the Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York explored outcomes between the two procedures. The concern of the authors is that laparoscopic radical prostatectomy might be overhyped by physicians and the advertising industry.

Dr. Yair Lotan, Department of Urology, University of Texas Southwestern Medical Center, Dallas, commenting on the study, explains, “A concern of these authors is the perception among patients that the robotic approach to prostatectomy is significantly superior", but there are a variety of treatment options for prostate cancer.

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Lotan says men might perceive that laparoscopic prostatectomy is superior to using an open technique because it is “reinforced by advertising from industry and physicians”. Men facing prostate cancer surgery need to know what to expect, and understanding there are few differences between open radical prostatectomy and laparoscopic prostatectomy is important for decision making.

An important note is that surgery outcomes also seem to be closely linked to the surgeon’s experience. Men who undergo prostate surgery do better with highly experienced surgeons, but that information is not widely publicized say the authors.

For the study, the researchers looked at outcomes among 6000 men undergoing prostate surgery. The authors write, “Results suggest that ORP and LRP have similar rates of postoperative mortality and morbidity. Controlling for important patient and tumor characteristics, the only differences favoring LRP were shorter length of stay and a lower risk of bladder neck or urethral obstruction. All men considering radical prostatectomy should be clearly informed about the differences between the 2 techniques and similarities in their expected outcomes, and make treatment decisions in collaboration with an experienced surgeon.”

The study found better outcomes for men undergoing laparoscopic procedure for prostate removal when it was performed by an experienced surgeon. The authors write, “Unfortunately this information is often harder to obtain than published reports from experts in the field.” Otherwise, few differences were found between open radical prostatectomy and laparoscopic prostatectomy, with or without robotic assistance. Outcomes of surgery for prostate cancer show little differences between surgery techniques according to the study review.

Journal of Urology

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