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Role of radical prostatectomy in the treatment of prostate cancer confined to prostate gland. Reality and myth, truth and fiction about robotic assisted radical prostatectomy


Authors: D. Pacík
Authors‘ workplace: Urologická klinika FN Brno
Published in: Urol List 2009; 7(3): 5-14

Overview

Without the possibility of prostate cancer primary prevention we are left with the strategy of secondary prevention – to diagnose the disease early, when it is confined to the prostatic capsule, and cure it only in patients who need it. Radical prostatectomy in present remains the best available modality for early treatment of prostate cancer. Since new so-called less invasive methods (laparoscopic and robotic-assisted) challenge the standard open surgery, the issue of which of these techniques achieves better results, is being frequently discussed. Because of the high purchase cost of these technologies such debates are often blurred with marketing strategies. We have to reject such tendencies and concentrate only on objective evidence-based medicine (EBM) data. The author discusses outcomes and drawbacks of individual techniques and shows that there is currently no evidence supporting any benefit of robotic-assisted ra­dical prostatectomy in terms of invasiveness, recovery and maintaining of urinary continence and erection. The results of these less invasive techniques in terms of oncologic outcome ere even worse – they are associated with higher incidence of so-called positive surgical margins. Surveys show 4,4times higher satisfaction rate in patients undergoing open surgery than in patients treated with robotic-assisted surgery. The adjuvant therapy was more (3,5times) frequently required in patients undergoing robotic-assisted surgery than in the other group.

Key words:
radical prostatectomy, open surgery, robotic assisted surgery


Sources

1. Holmberg L, Bill-Axelson A, Helgesen F et al. Scandinavian Prostatic Cancer Group Study Number 4. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.N Engl J Med 2002; 347 (11): 781–789.

2. Bill-Axelson A, Holmberg L, Ruutu M et al. Scandinavian Prostate Cancer Group Study No. 4. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352: 1977.

3. Wood DP, Schulte R, Dunn RL et al. Short-term health outcome differences between robotic and conventional radical prostatectomy. Urology 2007; 70: 945–949.

4. Menon M, Tewari A, Peabody JO et al. Vattikuti Institute prostatectomy for localized carcinoma of the prostate: Experience of over 1100 cases. Urol Clin North Am 2004; 31: 701–717.

5. Doležel J, Tvarůžek J, Zachoval R et al. Časné zkušenosti s roboticky asistovanou radikální pros­tatektomií (RRP). Česká urologie 2008; 12: 89.

6. Chuang AY, Nielsen ME, Hernandez DJ et al. The significance of positive surgical margin in areas of sur­gical incision in otherwise organ confined disease at radical prostatectomy. J Urol 2007; 178: 1306– 1310.

7. Da Vinci Prostatectomy. Available from: www.da­vin­ci­pros­tatectomy.com. Accessed June 21, 2008.

8. Eastham JA. Robotic-Assisted Prostatectomy: Is There Truth in Advertising? European Urology 2008; 54: s. 720–722.

9. Schroeck FR, Krupami TL, Sun L et al. Satis­factionand regret after ope nor robot-assisted laparoscopic radical prostatectomy. European Urology 2008; 54: 785–793.

10. Rojaz-Cruz C, Kulhalo JP. Sexual health misinformation on robotic prostatectomy web sites. Journal of Urology 2007; 177: 342.

11. Menon M, Shrivastava A, Kaul S et al. Vattikuti Insti­tute prostatectomy: contemporary technique and ana­lysis of results. European Urology 2007; 51: 648–658.

12. Montorsi F, Salonia A, Suardi N et al. Improving the preservation of urethral sphincter and neurovascular bundles during open radical retropubic prostatectomy. European Urology 2005; 48 (6): 938–945.

13. Masterson TA, Serio AM, Mulhall JP et al. Modified technique for neurovascular bundle preservation during radical prostatectomy: association between technique and recovery of erectile function. BJU Int 2008; 101: 1217–1222.

14. Hu JC, Wang Q, Pashos CL et al. Utilization and outcomes of minimally invazive radical prostatectomy. J Clin Oncol 2008; 26 (14), 2278–2284.

15. Ahlering TE, Skarecky D, Lee D et al. Successful transfer of open surgical skills to a laparoscopic enviroment using robotic interface: initial experience wth laparoscopic radical prostatectomy. J Urol 2003; 170: 1738–1741.

16. Herrell SD, Smith jr JA. Robotic-assisted laparoscopic prostatectomy: What is the learning curve? Urology 2005; 66: 105–107.

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