Minimally Invasive Radical Prostatectomy Has
Advantages, But Higher Rate of Complications
MIRP, especially with robotic assistance, increased from 1% to 40% of radical prostatectomies from 2001 to
2006,despite limited data on outcomes and costs
Oct. 14, 2009 - New research indicates that the use
of minimally invasive procedures (including the use of robotic
assistance) for radical prostatectomy, which have increased
significantly in recent years, may shorten hospital stays and decrease
respiratory and surgical complications, but may also result in an
increased rate of certain complications, including incontinence and
erectile dysfunction, according to a study in the October 14 issue of
the Journal of the American Medical Association (JAMA), a theme issue on
surgical care.
The findings of the study were presented by Jim C.
Hu, M.D., M.P.H., Brigham and Women's Hospital, Boston, at a JAMA media
briefing in Chicago.
Minimally invasive radical prostatectomy (MIRP), in
particular with the use of robotic assistance, has increased from 1
percent to 40 percent of all radical prostatectomies from 2001 to 2006.
But this rapid increase has occurred despite
limited data on outcomes and greater costs compared with open retropubic
radical prostatectomy (RRP; surgery in which an incision is made in the
lower abdomen to remove the prostate, which is located in the pelvis
behind the pubic bone).
"Moreover, the widespread direct-to-consumer
advertising and marketed benefits of robotic-assisted MIRP in the United
States may promote publication bias against studies that detail
challenges and suboptimal outcomes early in the MIRP learning curve.
Until comparative effectiveness of robotic-assisted MIRP can be
demonstrated, open RRP, with a 20-year lead time for dissemination of
surgical technique relative to MIRP, remains the gold standard surgical
therapy for localized prostate cancer," the authors write.
Dr. Hu and colleagues assessed the outcomes for men
with prostate cancer who underwent MIRP (n = 1,938) vs. RRP (n = 6,899),
using U.S. Surveillance, Epidemiology, and End Results Medicare linked
data. During the study period, the use of MIRP increased almost 5-fold,
from 9.2 percent in 2003 to 43.2 percent in 2006-2007.
After analyses, the researchers found that men
undergoing MIRP vs. RRP experienced shorter hospital length of stay
(median [midpoint], 2.0 vs. 3.0 days), were less likely to receive
transfusions (2.7 percent vs. 20.8 percent), and were at lower risk of
postoperative respiratory complications (4.3 percent vs. 6.6 percent)
and miscellaneous surgical complications (4.3 percent vs. 5.6 percent).
"However, men undergoing MIRP vs. RRP experienced
more genitourinary complications [involving the genital and urinary
organs or their functions; 4.7 percent vs. 2.1 percent) and were more
often diagnosed as having incontinence and erectile dysfunction. The
need for additional cancer therapies was similar by surgical approach,"
the authors write.
The researchers also found that greater receipt of
MIRP vs. RRP was associated with living in areas of higher socioeconomic
status based on education and income, and that this may be the result of
a "highly successful robotic-assisted MIRP marketing campaign
disseminated via the Internet, radio, and print media channels likely to
be frequented by men of higher socioeconomic status."
"In light of the mixed outcomes associated with
MIRP, our finding that men of higher socioeconomic status opted for a
high-technology alternative despite insufficient data demonstrating
superiority over an established gold standard may be a reflection of a
society and health care system enamored with new technology that
increased direct and indirect health care costs but had yet to uniformly
realize marketed or potential benefits during early adoption," the
authors conclude.
About Prostate Cancer Treatment by National Cancer
Institute
The treatment that's right for you depends mainly
on your age, the grade of the tumor (the Gleason score), the number of
biopsy tissue samples that contain cancer cells, the stage of the
cancer, your symptoms, and your general health. Your doctor can describe
your treatment choices, the expected results of each, and the possible
side effects. You and your doctor can work together to develop a
treatment plan that meets your medical and personal needs.
You may want to talk to your doctor about taking
part in a clinical trial, a research study of new treatment methods. See
the section on
Taking Part in Cancer Research.
Before treatment starts, ask your health care team
about possible side effects and how treatment may change your normal
activities. For example, you may want to discuss with your doctor the
possible effects on sexual activity. The NCI booklet
Treatment Choices for Men with Early-Stage Prostate Cancer can tell
you more about treatments and their side effects.
At any stage of the disease,
supportive care is available to relieve the side effects of
treatment, to control pain and other symptoms, and to help you cope with
the feelings that a diagnosis of cancer can bring. You can get
information about coping on the NCI Web site at
http://www.cancer.gov/cancertopics/coping and from NCI's Cancer
Information Service at 1-800-4-CANCER or
LiveHelp (http://www.cancer.gov/help).
Surgery
Surgery is an option for men with early (Stage I or
II) prostate cancer. It's sometimes an option for men with Stage III or
IV prostate cancer. The surgeon may remove the whole prostate or only
part of it.
Before the surgeon removes the prostate, the lymph
nodes in the pelvis may be removed. If prostate cancer cells are found
in the lymph nodes, the disease may have spread to other parts of the
body. If cancer has spread to the lymph nodes, the surgeon does not
always remove the prostate and may suggest other types of treatment.
There are several types of surgery for prostate
cancer. Each type has benefits and risks. You and your doctor can talk
about the types of surgery and which may be right for you:
► Open surgery: The surgeon makes a large
incision (cut) into your body to remove the tumor. There are two
approaches:
►
Laparoscopic prostatectomy: The surgeon removes the entire prostate
through small cuts, rather than a single long cut in the abdomen. A
thin, lighted tube (a
laparoscope) helps the surgeon remove the prostate.
► Robotic laparoscopic surgery: The surgeon
removes the entire prostate through small cuts. A laparoscope and a
robot are used to help remove the prostate. The surgeon uses handles
below a computer display to control the robot's arms.
►
Cryosurgery: For some men, cryosurgery is an option. The surgeon
inserts a tool through a small cut between the scrotum and anus. The
tool freezes and kills prostate tissue. Cryosurgery is under study. See
the section on
Taking Part in Cancer Research.
► TURP: A man with advanced prostate cancer may
choose TURP (transurethral
resection of the prostate) to relieve symptoms. The surgeon inserts
a long, thin scope through the urethra. A cutting tool at the end of the
scope removes tissue from the inside of the prostate. TURP may not
remove all of the cancer, but it can remove tissue that blocks the flow
of urine.
Sarcosine is better indicator of advancing disease
than traditional prostate specific antigen test (PSA); it is detected in
urine, researchers hopeful simple urine test can be used
Oct. 14, 2009 - New research indicates that the use
of minimally invasive procedures (including the use of robotic
assistance) for radical prostatectomy, which have increased
significantly in recent years, may shorten hospital stays and decrease
respiratory and surgical complications, but may also result in an
increased rate of certain complications, including incontinence and
erectile dysfunction, according to a study in the October 14 issue of
the Journal of the American Medical Association (JAMA), a theme issue on
surgical care. 
