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Adapted from the NCI Cancer Bulletin, vol. 6/no. 20, October 20, 2009 (see the current issue).
Minimally invasive surgeries to remove the prostate in men with prostate cancer, including procedures performed with a surgical robot, are superior to standard "open" prostate removal surgeries by some measures but fall short on several other important outcomes, including risk of incontinence and erectile dysfunction. The study was published October 14, 2009 in the Journal of the American Medical Association.
From 2003 to 2007, the number of minimally invasive radical prostatectomy (MIRP) procedures increased from 1 percent to more than 40 percent of all prostatectomies, an increase that the researchers believe has been largely driven by the rapid proliferation of robotic surgery. Currently, robotic prostatectomy accounts for 70 percent of all MIRP procedures, said the study's lead author Dr. Jim C. Hu of Brigham and Women's Hospital in Boston.
The study was not a randomized clinical trial. Rather, the researchers used billing and diagnostic data from NCI's SEER-Medicare database, identifying 1,938 men who underwent MIRP and 6,899 men who underwent open surgery. After accounting for differences in physician and patient characteristics in men receiving MIRP versus open procedures, the researchers found that men who underwent MIRP had shorter hospital stays (2 days versus 3 days), far fewer blood transfusions, and a lower risk of respiratory and other surgical complications. But they also had more than twice the risk of genitourinary complications, a 30 percent increased risk of incontinence, and a 40 percent increased risk of erectile dysfunction 18 months after the procedure.
The need for additional cancer therapies was roughly equivalent between the groups, Dr. Hu explained, suggesting that neither procedure is superior in terms of cancer control. The study also revealed several disparities related to MIRP, including less frequent use by African American and Hispanic men.
Given the available data on standard open surgery compared to MIRP, said Dr. Hu, open surgery should remain the "gold standard" for men who opt for surgery to treat localized prostate cancer. |
