New study suggests that less invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotency when compared with traditional surgery. Newer doesn't always mean better as Dr. Gregory Echt, Prostate Seed Institute in Dallas explains.
(PRWEB) November 13, 2009 -- A new study by Jim C. Hu, MD, MPH, at Brigham and Women’s Hospital in Boston reported on the choice of Robotic Surgical Treatment for prostate cancer. The study appeared in the October 2009 Journal of the American Medical Association, and it compared the effectiveness of minimally invasive radical prostatectomy (MIRP) vs. open radical retropubic prostatectomy (RRP).
The public presumes that what is newest must be best. Doctors, however, are “show-me” professionals. “Actually, we need peer-reviewed evidence based on outcomes and side effects to prove that certain interventions are better than others,” says Gregory A. Echt, MD, radiation oncologist and director of the Prostate Seed Institute in Dallas, Texas. “The results of Dr. Hu’s study suggests that less invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotency when compared with traditional surgery.”
For this study, the researchers analyzed Medicare data of 9000 patients who had radical surgery for prostate cancer from 2003 through 2007. Of those, 1938 patients had minimally invasive surgery (MIRP) and 6899 patients had radical retropubic prostatectomy (RRP). The data did not indicate how many of the MIRP patients involved robotic or laparoscopic techniques. Robotic prostatectomies have become very popular due to considerable marketing-led enthusiasm for robotic surgery and the American public’s interest in new technology.
Dr, Echt is not sure the study clears up the confusion some patients feel as they consider all treatment options. “The results can be confusing as some treatments offer different outcome probabilities for urinary and sexual side effects,” he says. “However, the data still shows that radiation therapy and prostate seed implantation therapy is equivalent to outcomes with radical prostatectomy.”
There has been rapid adoption of robotic surgery which is a relatively new technique. For patients who had keyhole surgery, they left the hospital earlier, in two days vs. three for open techniques. They also had lower rates for blood transfusion, breathing problems, and internal scarring. There was no difference, however, in the rate of additional cancer therapy necessary down the road, such as external beam radiation therapy for positive margins. These results suggest that the two techniques were about the same for cancer control.
The men who had keyhole surgery, however, were more likely to report complications in the first thirty days post-operatively involving genitourinary function. Approximately 5% of the minimally invasive patients vs. 2% of the standard surgical patients had these complications.
After 18 months minimally invasive patients had more incontinence and erectile dysfunction.
Certainly there is a place for robotic prostatectomies, notes Dr. Echt. “Although it is more likely the surgeon doing the procedure is key. By that I mean there is a considerable learning curve associated with minimally invasive techniques. It may take 300 cases or so for a surgeon to become really competent in those techniques.”
The take home message to the patients would be that if they are interested in minimally invasive operations, whether it be robot or laparoscopic assisted, to make sure that the surgeon is very experienced. “I would insist the surgeon to have done at 150-200 cases,” says Dr. Echt. “It is also important for patients to get second opinions regarding other options such as radiation therapy.”
Typically patients with early prostate cancer have identical cure rates and biochemical disease-free survival rates at 15 years whether they have a radical prostatectomy or a prostate seed implant.
Patients should keep in mind that prostate brachytherapy, unlike surgery, takes only about an hour. Following the procedure, patients leave without a catheter and are back to work in approximately two days or so, with no risk of urinary incontinence. Another important factor is that erectile dysfunction probabilities are lower than those with radical prostatectomy.
Dr. Echt notes that Dr. Hu’s study will most likely not dampen enthusiasm for robotic surgery. He does, however encourage patients to “Do their homework and understand the various options and various risk profiles for any of the treatments discussed.”
About the Author:
Dr. Gregory A. Echt is among the top radiation oncologists performing prostate seed implant procedures in the United States. Prostate Seed Institute (www.prostateseedinstitute.com) is a prostate cancer treatment clinic founded and directed by Dr. Gregory A. Echt. In his 17 years of practice as a radiation oncologist, Dr. Echt has treated prostate cancer with seed implantation in more than 3000 men, including urologists and other radiation oncologists.
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