Less Invasive Prostate Removal Shown to Be Safer for Patients Than Traditional Surgery, Large Study Says
Researchers Question Why Complications Including Death from Open procedure Increased over Time: Call for Further Study
For the first time ever, surgeons who operate on men with prostate cancer have results from a large study to backup what many suspected all along: minimally-invasive methods to remove the prostate pose fewer post-surgical complications, present less need for blood transfusion and allow men to leave the hospital sooner. More importantly, given the large sample of more than 78,000 men, researchers also were able to determine a statistically lower chance of postoperative death within 30 days after minimally invasive surgery compared to open surgery.
But researchers also found something they didn’t expect: complications increased over time for the traditional open procedure.
The study is published in the April 2012 issue of European Urology.
“This study is noteworthy because we looked at data from 100% of Medicare patients in the United States, not in just one hospital or one geographic area,” said study first author Keith Kowalczyk, M.D. of MedStar Georgetown University Hospital, who performed the study with Jim C. Hu, M.D., MPH of the Department of Urology at the David Geffen School of Medicine at UCLA.
“So these results reflect what’s really happening in communities across America today, not just in high volume academic centers where most of our data comes from. Also, since the numbers were provided by the Center for Medicare Services, we were able to look at a larger number of patients than previous studies. That enabled us to detect statistically significant differences in outcomes between the two methods that earlier studies might not have captured,” said Dr. Kowalczyk.
What Is Prostate Removal?
Prostate removal, or prostatectomy, is a surgical procedure to remove all or part of a man’s prostate gland. This procedure is performed to treat:
Prostate enlargement (benign prostatic hyperplasia, or BPH)
Prostate cancer
The prostate, a gland found only in males, is located under the bladder and in front of the rectum. It surrounds the neck of the bladder and the urethra, which is the tube that drains the bladder. In an adult man, the prostate is about the size of a walnut.
The prostate is one of three glands necessary for reproduction. The prostate produces a sticky, milky fluid of acids and enzymes. This fluid makes up about 15 percent of the total volume of the semen and helps to sustain the sperm cells that are created in the testicles. The prostate is surrounded by muscle, which contracts to ejaculate this fluid.
Complications included respiratory, cardiac, surgical and genitourinary, including urinary tract infections, kidney infections, kidney obstructions and bladder problems.
The study looked at 78,232 men over the age of 65 who had their prostate removed due to prostate cancer between 2003 and 2007. Minimally invasive radical prostatectomy (MIRP) was performed on 19,594 men using either laparoscopy or robotic technology like the da Vinci robotic system; open retropubic radical prostatectomy (RRP) was used in 58,638 men.
At the beginning of the time period studied, minimally invasive techniques were performed in fewer than 5-percent of cases but rose to being used 44.5-percent of the time.
Facts About Prostate Removal
- Prostate removal (prostatectomy) takes about two to four hours to perform.
- Prostate removal involves a hospital stay of up to 5 days.
- Prostatectomy can be used to treat prostate enlargement, which affects at least half of all men by age 50 and at least 80 percent of all men by age 80.
- About 90 percent of men who have their prostate removed to treat prostate enlargement benefit significantly from the procedure.
- Prostatectomy can be used to treat prostate cancer, which affects an estimated 189,000 men in the U.S. each year.
- Complications of prostate removal surgery include impotence (the inability to have or maintain an erection) and incontinence (the inability to control urination).
By contrast, use of the standard procedure decreased from 89.4-percent in 2003 to 52.9- percent by 2007.