ORRP vs. RALP in a large cohort of high-risk patients with localized prostate cancer

A relatively large, retrospective, single-institution cohort study appears to show that oncologic outcomes after robot-assisted laparoscopic prostatectomy (RALP) are comparable to those achieved after open retropubic radical prostatectomy (ORRP) among high-risk patients when the operations are carried out by appropriately skilled and experienced surgeons.

Punnen et al. compared data from a cohort of 410 high-risk prostate cancer patients, all of whom underwent radical surgery at the University of California San Francisco between 2002 and 2011.

Analysis of data from these 410 patients showed the following results:

  • 177/410 patients (43.2 percent) were treated with ORRP.
  • 233/410 patients (56.8 percent) were treated by RALP.
  • The average (mean) age of the patients was 61.6 ± 6.6 years.
  • The average (median) follow-up was 27 months (range, 2 to 112 months).
  • Compared to patients treated by ORRP, the patients treated by RALP
    • Had less perioperative blood loss (median blood loss of 200 ml vs. 400 ml, P < 0.01)
    • Underwent complete bilateral nerve sparing more often (54 vs. 34 percent, P < 0.01)
    • Demonstrated no differences in terms of pathological grade, stage, or rates of positive margins
  • Biochemical recurrence-free survival rates after ORRP and RALP were similar.
    • Recurrence-free survival rates after ORRP were
      • 84 percent at 2 years
      • 68 percent at 4 years
    • Recurrence-free survival rates after RALP were
      • 79 percent at 2 years
      • 66 percent at 4 years
  • There was a trend towards higher rates of positive margins among men treated with RALP early in the series (i.e., before significant experience levels had been accumulated).

Punnen et al. conclude that, “RARP appears to be a feasible option for men with high-risk prostate cancer and displayed equivalent oncological outcomes compared with open RRP.”

The paper appears to offer no comparative data on the side effects, complications, or times to recovery of continence or sexual function associated with the two differing forms of surgery.

4 Responses

  1. So that means we should opt for ORRP because it is just as good as RALP but much cheaper. It is the same story with proton radiation therapy; it gives exactly the same results as IMRT but much more expensive.

    These fancy gadgets (treatments) offer no better treatments and only enrich the manufacturers.

  2. Dear Mr. Buxton:

    The important factor is not the technology; it is who is using it. That is particularly the case when it comes to surgery!

  3. I would opt for RALP. Half the blood loss, nerve sparing more often, and something not compared but known: a shortened hospital stay.

    The surgery is more but why do they not factor in reduced hospital stay, and how much sooner I can get back to work.

    The biochemical recurrence-free survival rates are close enough with such a small sample size to be statistical noise.

  4. I would much appreciate comments from anyone who has had a RALP at UCSF, regards identifying a surgeon there with extensive experience on the procedure. Can’t find much information via the various prostate cancer sites about this aspect of the UCSF Urology department.

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