Robotic vs Traditional Prostate Surgery – What Works Best?


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According to a recent survey, there is little difference in the results of the expensive robotic surgery for prostate cancer (da Vinci) surgical procedure over low-tech traditional prostate surgery. The new survey that found complaints about erectile dysfunction and incontinence in men were equally common after the two procedures.

“I wasn’t surprised at all,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who wasn’t involved in the study.

“Unfortunately, robotic prostatectomy — like many things in prostate cancer — has gotten a lot more hype than it should.”

Robotic prostatectomy has caught on rapidly in the U.S as a treatment for prostate cancer, notwithstanding that there is little evidence to show it’s better than traditional prostate removal. It is, however, much more costly, adding some $2,000 in hospital costs per procedure.

The new study, published in the Journal of Clinical Oncology, is based on responses from more than 600 prostate cancer patients on Medicare, the government’s health insurance for the elderly. About 400 of the men in the study had robotic-assisted laparoscopic prostatectomy, in which the surgeon uses a robot to access the prostate through multiple small holes in the belly.

The rest of the patients had traditional open surgery, in which the prostate is removed through one long cut in the belly.

Nearly nine out of 10 men had a moderate or significant problem with erectile dysfunction 14 months after their surgery. Dr. Michael Barry of Massachusetts General Hospital in Boston and colleagues also found that about a third of the men said they had urinary incontinence trouble after their surgery. Overall, there were no differences between the two patient groups, although incontinence problems appeared to be slightly more common after the robot procedure for prostate cancer.

Read more in our Prostate Cancer Health Center.

Reference

Barry MJ et al. Adverse effects of robotic-assisted laparoscopic versus open retropubic radical prostatectomy among a nationwide random sample of medicare-age men. Journal of Clinical Oncology 2012 Feb 10; 30(5): 515-18