Consider the Evidence:

Comparing Traditional Radical Prostatectomy to Robotic Prostate Surgery

Categories: Summer/Fall 2018
Robotic prostate surgery continues to grow in popularity, yet published research does not demonstrate that robotic surgery leads to better results.
To interpret things clearly, it’s best to confront the evidence directly. ©Dan Oldfield

Robotic prostate surgery continues to grow in popularity, yet published research does not demonstrate that robotic surgery leads to better results.

The rise in popularity seems to primarily stem from aggressive marketing campaigns. Quality scientific research has not shown that the outcomes which matter most to patients – curing cancer and maintaining urinary continence and sexual potency – are better with robotic surgery.

Survival rates depend on the surgeon’s skill

Most studies that seem to favor robotic prostatectomy for prostate cancer survival rates have flawed approaches. For example, a widelyquoted study compared survival rates of patients who had open radical prostatectomies with robotic prostatectomies, but men in the two treatment groups were diagnosed during different screening eras. This skewed the data in favor of robotic prostatectomies, as men in this group were able to be diagnosed with earlier detection of prostate cancer.

Patients should consider the surgeon’s experience and skill when considering their treatment options. For instance, a study at Johns Hopkins with 20 years of follow-up looked at patients who had traditional open surgery for clinically significant prostate cancer that was contained within the prostate. The same experienced surgeon performed all the open prostatectomies for patients in the study, and virtually nobody died of prostate cancer. The cancer-specific survival rate was nearly 100%. It would be hard for robotic surgery to improve on these results, and no evidence like this exists for any other type of prostatectomy. The open radical prostatectomy is the “gold standard” to which all other treatment options should be compared.

“There are no rigorous long-term cancer control data
on robotic surgery. The most important outcome is cancer control, and the most important single factor
is surgical expertise”

– William J. Catalona, M.D.

Treatment side effects

Continence and potency also have not been consistently shown to be better with robotic surgery. The Spring 2018 issue of QUEST covered two recent studies comparing these outcomes with traditional and robotic prostate surgery. See “Robotic-Assisted Prostatectomy Does Not Lead to Better Sexual or Urinary Function” on page 5 of the issue. Dr. Catalona’s surgical complication rate in the national PROPUBLICA SURGEON SCORECARD database, which reports the surgical complication rate for every surgeon in every hospital in the U.S., is at least as low or lower than those of robotic prostatectomy surgeons across the country.

The recovery from open and robotic surgeries are essentially the same, although robotic procedures are generally more expensive.

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