Study: Robotic Surgery Does Not Lessen Common Side Effects from Prostate RemovalJan 25, 2012
Surgery to remove the prostate is an option for men diagnosed with prostate cancer that has not spread. If the surgery is successful, all the cancer is removed along with the prostate. However, the surgery can cause side effects that include sexual problems and urinary incontinence.
Most men who have the surgery today undergo a newer procedure that uses robotic technology. This type of surgery is often advertised as being more convenient for the patient, allowing for quicker recovery from surgery. Some men may also assume this means it will have fewer side effects down the line. But a team led by researchers from Massachusetts General Hospital found that men were just as bothered by sexual and urinary side effects when they had robotic surgery as when they had traditional surgery.
Most men report side effects after surgery
Researchers asked more than 600 men about their recovery from prostate removal surgery in 2008. All of the men were Medicare patients and were 65 or older. About 400 of them had surgery using robotic technology, and the other 200 or so had traditional surgery. Overall, there were no significant differences in side effects between the 2 groups. About 90% said they had trouble with sexual function and about 30% said they had incontinence.
The study was published as an early release on January 3, 2012 in the Journal of Clinical Oncology.
Traditional surgery to remove the prostate is called radical retropubic prostatectomy. While the patient is under anesthesia, the surgeon makes a long incision in the abdomen (from the belly button to the pubic bone) to remove the prostate.
The robotic surgery is actually called robotic-assisted laparoscopic radical prostatectomy (RALRP). The surgeon sits at a panel near the operating table and controls robotic arms to perform the operation through several small incisions in the patient's abdomen. Because it uses small incisions, this technique has some advantages over the standard surgical approach, including less blood loss and pain, shorter hospital stays, and faster recovery times.
RALRP has been in use in the US since 2003. As many as 85% of the men who have their prostate removed (56,000 in 2005) now have RALRP, according to the researchers, even though no clinical trials have shown that it is more effective or that patients have any better quality of life after recovering from the surgery.
In an accompanying editorial, doctors from the University of California, San Francisco suggest that heavy advertising for the robotic surgery and a faith in new technology may be encouraging more men to opt for RALRP. The authors cite research that shows men opting for RALRP tend to have higher expectations than those opting for traditional surgery, and tend to be more likely to regret their decision.
Make an informed decision
For men who decide to have prostate removal surgery, choosing the right surgeon is very important, regardless of the type of operation. Durado D. Brooks, MD, American Cancer Society director of prostate and colorectal cancer, recommends men ask these questions:
- How many prostate removal surgeries of the type I’m considering have you performed?
- How many do you perform each year?
- How many are done each year in the hospital where I will be receiving care?
- Do you keep track of how many patients have sexual problems, incontinence, or recurrence of their cancer?
- How do these outcomes compare with those reported by other surgeons (locally and nationally)?
Higher numbers of surgeries performed are associated with better outcomes among individual surgeons and hospitals. The authors of the editorial cite research that says about half the prostate removal surgeries are performed by surgeons who do fewer than 5 per year. Only about 1 in 5 are done by surgeons who perform more than 30 per year.
For more information, see our document, What should you ask your doctor about prostate cancer?
Some men can consider active surveillance
According to Dr. Brooks, approximately half of patients undergoing prostate surgery have low-risk disease and may not need treatment right away. Many of these men may be good candidates for active surveillance. In a recent blog, Dr. Brooks defines active surveillance as monitoring the cancer closely and delaying active treatment (surgery or radiation, for instance) until there are signs it is needed (which in some cases may be never).
Dr. Brooks said, “Every man considering treatment should ask whether he is potentially a candidate for active surveillance. And if not, why not?”
Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men. Published as an early release on January 3, 2012 in the Journal of Clinical Oncology. First author: Michael J. Barry, Massachusetts General Hospital, Boston.