The “New” Prostate Cancer InfoLink has long been pointing out the lack of any evidence that men who are treated with robot-assisted laparoscopic prostatectomy (RALP) will have better outcomes with respect to continence and sexual function than men who elect to have the older, “open” form of radical prostatectomy.
A recently published study by Barry et al. has now confirmed the accuracy of our opinion on this matter, noting that “Medicare-age men should not expect fewer adverse effects following robotic prostatectomy” than have historically been observed in men having open surgery.
We should be clear up front that there are short-term benefits associated with RALP as compared to open surgery. These include: a reduction in risk for blood loss and for resultant blood transfusion during surgery; less post-operative pain; and a shorter postoperative recovery time. However, many men are under the mistaken illusion that RALP is also associated with a higher probability of complete continence and better sexual function than open surgery.
Barry and his colleagues set out very specifically to compare the risks of problems with continence and sexual function following the two different types of radical prostatectomy among Medicare-age men. They did this by using a random sample of Medicare claims submitted between August 1 and December 31, 2008. All patient participants had hospital and physician claims for radical prostatectomy, diagnostic codes for prostate cancer, and reported being treated with either RALP or open surgery. They were asked to complete a mail survey that included self-ratings of problems with continence and sexual function at an average (median) of 14 months after their surgery.
Here are the survey results:
- 685/797 eligible patients (85.9 percent) returned completed surveys.
- Of these 685 eligible patients
- 406 men (59.3 percent) reported having had a RALP.
- 220 men (32.1 percent) reported having had open surgery.
- 189/607 men (31.1 percent) reported having a moderate or big problem with continence.
- 522/593 men (88.0 percent) reported having a moderate or big problem with sexual function.
- Model-based analyses, with appropriate adjustments for patient age and educational level, predicted that
- RALP was actually associated with a non-significant trend toward greater problems with continence (odds ratio [OR] = 1.41).
- RALP was not associated with greater problems with sexual function (OR = 0.87).
In other words, even though RALP is now much more common than open radical prostatectomy as a surgical treatment for men with clinically localized prostate cancer, there are in fact no data to suggest that post-surgical continence or sexual function are any better after RALP than they are after open surgery.
Now, carefully selected surgeons may indeed be able to demonstrate that their personal outcomes (in terms of continence and sexual function) are in fact “better than the average” using either open surgical procedures or RALP. As The “New” Prostate Cancer InfoLink regularly observes, the skill levels of individual surgeons are much more likely to be a key factor in such outcomes than the technology used to carry out the surgery. Some physicians may be able to achieve such results through the use of robot-assisted techniques; others may prefer to use open surgery. What one can not expect, however, is that having one’s surgery carried out with robot assistance necessarily improves the probability of high continence and good sexual function post-surgery.