Researchers from Harvard University have reported that men undergoing minimally invasive radical prostatectomy (MIRP) have “a shorter hospital stay, fewer respiratory and miscellaneous surgical complications and strictures, and similar postoperative use of additional cancer therapies but experienced more genitourinary complications, incontinence, and erectile dysfunction” than men undergoing conventional open retropubic prostatectomy (RRP). The details of this study appeared in the October 14, 2009 issue of the Journal of the American Association.[1] 

Laparoscopic radical prostatectomy and more recently laparoscopic robotic radical prostatectomy (introduced in 2000), have become very popular treatments for men with localized prostate cancer. These two techniques are referred to as MIRP for purposes of the current study. Although MIRP techniques have been available for over two decades there is still debate about whether these techniques are superior to RRP. No randomized trials have been performed or are being planned to evaluate the relative effectiveness of MIRP vs RRP. Thus, physicians and patients have to rely on non-randomized comparisons to help decide if MIRP is appropriate therapy for prostate cancer. One of the main reasons many younger patients are selecting MIRP is the belief that this technique will preserve erectile function. However, there are no data to substantiate this claim. 

The current study was a population-based observational cohort study using US Surveillance, Epidemiology, and End Results-Medicare linked data from 2003-2007 to identify 8837 men who had prostate cancer treated with radical prostatectomy. 6899 men underwent RRP and 1938 MIRP. 

These authors made the following observations about the demographics of men choosing MIRP vs RRP: 

• MIRP increased from 9.2% of all prostatectomies in 2003 to 43.2% in 2006-7.
• 6.1% of men undergoing MIRP were Asian compared with 3.2% of men who underwent RRP.
• 6.2% of men undergoing MIRP were black compared with 7.8% of men who underwent RRP.
• 5.6% of men undergoing MIRP were Hispanic compared with 7.9% of men who underwent RRP.
• Men who underwent MIRP were more educated and more affluent than men undergoing RRP.

Relative effectiveness of MIRP vs RRP included the following results: 

• Median hospital stay was 2 days for MIRP and 3 days for RRP.
• 2.7% of patients receiving MIRP had blood transfusions vs 20.8% of RRP patients.
• Postoperative respiratory complications occurred in 4.3% of MIRP patients vs 6.6% of RRP patients.
• Anastomotic strictures occurred in 5.8% of MIRP patients and 14.0% of RRP patients.
• Genitourinary complications occurred in 4.7% of MIRP patients and 2.1% of RRP patients.
• The rate of incontinence was 15.9 per 100 person-years in MIRP patients vs 12.2 per 100 person-years in RRP patients.
• The rate of erectile dysfunction was 26.8 per 100 person-years in MIRP patients vs 19.2 per 100 person-years in RRP patients. 

Comments: These authors concluded that “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 costs but had yet to uniformly realize marketed or potential benefits during early adoption.” 

Related News: 

Learning Curve for Laparoscopic Prostatectomy Slower than for Open Surgery (04/06/2009) 

Laparoscopic Robotic Surgery Effective for Localized Prostate Cancer (05/16/2008) 

Laparoscopic Prostatectomy as Effective as Open Prostatectomy (03/18/2008) 

Study Suggests No Difference in Outcomes for Open Versus Robotic Surgery for Prostate Cancer (10/02/2008) 

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) 

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