The current data on RALP for localized prostate cancer

A new review in BJU International — available in full on the Web through the UroToday web site — provides a detailed review of the currently available data on the use of robot-assisted laparoscopic prostatectomy (RALP) for the treatment of localized prostate cancer.

This article by Coelho et al., although written by surgeons specializing in the use of RALP, provides a useful and relatively complete overview of data published between 2006 and the first half of 2009 on the use of RALP as a first-line treatment, with references and data from most of the large, published series of patients currently available. In particular this paper will be useful for support group leaders and othjers with an interest in patient education and resources.

Based on the data they discuss in the review, the authors express the opinion that:

  • RALP is associated with decreased operative blood loss and decreased risk of transfusion by comparison with open radical retropubic prostatectomy.
  • RALP is associated with excellent functional and oncological outcomes, as reported in large series.
  • Preliminary data suggest that RALP is associated with a reduced period of hospitalization post-surgery
  • Preliminafrty data also suggest that RALP is associated with lower rates of positive surgical margins, early potency, and early continence.

However, the authors also note that “the lack of prospective randomized studies precludes definitive conclusions” about the relative merits of robot-assisted minimally invasive surgery as compared to older open procedures.

The “New” Prostate Cancer InfoLink is skeptical that there will ever be meaningful randomized and suitably conmtrolled trials that can effectively compare two surgical techniques that are so highly dependent on the individual skills of specific surgeons. We should take this review for what it is, an assessment of the “state of the art” by surgeons who specialize in the use of this technique. Surgeons who specialize in the practice of open radical prostatectomy — and those who practice non-robotic forms of laparoscopic surgery — would inevitably interpret some of these data from a different viewpoint.

One Response

  1. Although I am a proponent of RALP, I certainly concur with The “New” Prostate Cancer InfoLink position in the final paragraph.

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