Robotic v Open Prostate Cancer Surgery

A recent study, involving 300 men who were randomized to open or robotic surgery, from Queensland Australia,  published in the Lancet Oncology compared robotic to open prostate cancer surgery (prostatectomy).

The study found that over a two-year period both forms of surgery produced equivalent results for preserving erectile function and urinary continence.   

The results were equal at 12 weeks and remained so at six, 12 and 24 months.

Surgical results were equivalent too with the same rates of positive margins (cancer at the edge of the removed tissue) and follow-up scans for cancer showed no visible differences.

Since the researchers found both types of surgery equal in outcomes, the researchers stated that they felt robotic surgery is a safer option due to it being less invasive.  Robotic surgery also seems to cause less pain, less physiological distress during the operation and the surgical recovery is faster.  The researchers also cited that robotic surgery causes less blood loss which lowers the need for blood transfusions. 

The study was funded by Cancer Council Queensland, the study was led by the Royal Brisbane and Women's Hospital and Menzies Health Institute Queensland.

The trial had an unexpected finding. The men having robotic surgery had alower PSA recurrence (3% v 9%).   However, according to the researchers, the reason and the possible significance of the differences in the levels of PSA can’t be teased out from this study and can't be relied upon to draw any conclusions since the management of the men post-surgery was not standardized.

The researchers also found 20 per cent of men in the trial, in both surgical groups, suffered continual and enduring psychological distress.  This finding is concerning and clearly indicates that our management of men who have prostate cancer surgery needs to include psychological distress screening and treatment when needed.  Currently, psychological assistance is lacking at most institutions. 

Joel T. Nowak, MA, MSW wrote this Post.  Joel is the CEO/Executive Director of Cancer ABCs.  He is a Cancer Thriver diagnosed with five primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma, and the rare cancer Appendiceal cancer.