Study of Senior Men Finds Similar Results With Open
or Laparoscopic Prostate Surgery
Researchers studied almost 6,000 senior citizens,
suggest patients be informed about the differences and similarities in
expected outcomes, make treatment decisions with an experienced surgeon
Feb. 22, 2010 – Of the 200,000 men newly diagnosed
with prostate cancer each year in the United States, about one-third
will undergo surgical treatment. Although open radical prostatectomy (ORP)
is regarded as the standard treatment, laparoscopic radical
prostatectomy (LRP) with or without robotic assistance is becoming more
common. Yet, a new study of senior men – aged 66 or older - published
today says the two methods have similar rates of success.
In the study published online in The Journal of
Urology, researchers from the Urology Service, Department of
Surgery, Memorial Sloan-Kettering Cancer Center, New York, advise that
men considering prostate cancer surgery should understand the expected
benefits and risks of each technique to facilitate decision making and
set realistic expectations.
Enthusiasm for LRP, specifically for LRP with
robotic assistance, has grown rapidly despite limited evidence of its
superiority to ORP.
While most studies to date have been based on a
limited number of patients or from single institutions, the authors of
the current study compared ORP and LRP outcomes in a population based
cohort of almost 6,000 men 66 years of age or older with clinically
localized prostate cancer.
"A concern of these authors is the perception among
patients that the robotic approach to prostatectomy is significantly
superior. This perception is often reinforced by advertising from
industry and physicians, commented Dr. Yair Lotan, Department of
Urology, University of Texas Southwestern Medical Center, Dallas.
“Patients deserve to have a realistic expectation
of surgical outcomes, especially considering the multiple other
available treatment options. Notably the main information that a patient
must know is not the prostatectomy approach but surgeon experience.
“Several studies show that the primary determinant
of prostatectomy outcome is surgical volume. Patients should be educated
on likely outcomes of a procedure based on individual surgeon
experience. Unfortunately this information is often harder to obtain
than published reports from experts in the field."
After adjusting for patient and tumor
characteristics, there were no differences in the rate of general
medical/surgical complications or genitourinary/bowel complications, or
in postoperative radiation and/or androgen deprivation.
LRP was associated with a 35% shorter hospital stay
and a lower bladder neck/urethral obstruction rate. In laparoscopic
cases, the surgeon's experience with the procedure was inversely
associated with hospital stay and the odds of any genitourinary/bowel
complication.
Writing in the article, William T. Lowrance, MD,
and colleagues state, "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."
Information source:
The article is "Comparative Effectiveness of
Prostate Cancer Surgical Treatments: A Population Based Analysis of
Postoperative Outcomes" by William T. Lowrance, Elena B. Elkin, Lindsay
M. Jacks, David S. Yee, Thomas L. Jang, Vincent P. Laudone, Bertrand D.
Guillonneau, Peter T. Scardino and James A. Eastham. It is published
online (DOI:10.1016/j.juro.2009.12.021) and will appear in The
Journal of Urology, Volume 183 Issue 4 (April 2010) published by
Elsevier.
MIRP, especially with robotic assistance, increased from 1% to 40% of radical prostatectomies from 2001 to
2006,despite limited data on outcomes and costs
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
Feb. 22, 2010 – Of the 200,000 men newly diagnosed
with prostate cancer each year in the United States, about one-third
will undergo surgical treatment. Although open radical prostatectomy (ORP)
is regarded as the standard treatment, laparoscopic radical
prostatectomy (LRP) with or without robotic assistance is becoming more
common. Yet, a new study of senior men – aged 66 or older - published
today says the two methods have similar rates of success.
