Researchers from Columbia University and the Henry Ford Health Systems have reported that laparoscopic robotic prostatectomy (LRP) provides excellent cancer control and good functional outcome in 2,766 men with localized prostate cancer. The details of this study appeared in April 2008 issue of The American Journal of Hematology/Oncology.¹

The Da Vinci Robotic Surgical System for performing LRP was introduced in 2000. This technique has become very popular in some medical centers and it is currently estimated that more than 10% of all prostatectomies are performed by LRP. The purported advantages of this technique are that it allows surgeons to perform prostatectomy with minimal blood loss and with shorter recovery time. In a study from Duke University, LRP was associated with an approximate $1,000 increase in surgical cost over conventional robotic prostatectomy (RP), but this was offset by lower hospitalization costs. However, there is still controversy over whether or not LRP is superior to conventional RP, and no randomized trials have been performed or are being planned. Thus, physicians and patients have to rely on non-randomized comparisons to help decide if LRP is appropriate therapy for prostate cancer. One of the main reasons many younger patients are selecting LRP is the belief that this technique will preserve erectile function. However, there are no data to substantiate this claim. Another study from Duke University Medical Center and the University of Florida reported that patients undergoing LRP have similar functional outcomes as patients undergoing perineal prostatectomy. The follow-up of this study was 12 months.

The current study of LRP involved 2,766 men with localized prostate cancer treated by LRP between 2000 and 2006. Mean age was 60.2 years, and the mean PSA was 6.4. Twenty-two percent had T2 or greater stage disease and 10.7% had a PSA >10. Mean surgical time was 154 minutes. Estimated blood loss was 100 mL, and the hospital time was less than 24 hours for 97% of patients treated with LRP. Operative time decreased over time with the most recent group having a procedure time of 131 minutes. Only 14 patients required reexploration, and 12% had minimal complications. The median follow-up in this study was 27 months. Sexual function appeared to be present in 79% of men who were potent preoperatively. Mean time to continence recovery was three weeks. Ninety-three percent of men were completely continent at one year. The PSA recurrence rate was 7%, and the five-year actuarial biochemical-free recurrence rate was 84%.

These authors concluded that more time would be needed to determine cancer-specific survival.

Comments: Laparoscopic robotic surgery can now be added to the relatively long list of available therapies for the treatment of men with localized prostate cancer including: conventional surgery, laparoscopic surgery, external beam radiotherapy, brachytherapy, and cryotherapy. Unfortunately, there are no randomized controlled trials to help determine optimal treatment, and patients have to rely on Phase II data and physician preference to dictate the type of therapy they will receive.

Related News:

Functional Outcomes of Robotic Prostatectomy Similar to Conventional Prostatectomy (05/29/2007)

Length of Hospital Stay Similar for Robotic Assisted and Conventional Prostatectomy (03/12/2007)

Reference:

¹ Badani KK, Krane L, Menon M. Robotic radical prostatectomy: Oncologic and funcional outcomes after 2766 prodedures. The American Journal of Hematology/Oncology. 2008;7:139-141.