Pros and cons with “easier” prostate cancer surgery

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More and more men with prostate cancer who opt to have the organ surgically removed are choosing less invasive keyhole “prostatectomy” over the more traditional open or “radical” prostatectomy.

But a study released today shows that men who have the keyhole surgery run a higher risk of certain complications, including erectile dysfunction and incontinence.

In traditional open prostatectomy—the “gold standard”—an incision is made in the lower abdomen to remove the prostate, which is located in the pelvis behind the pubic bone. 

Use of the newer less invasive keyhole procedure, in particular with the use of robotic assistance, has increased dramatically in recent years, from 1 percent to 40 percent of all radical prostatectomies from 2001 to 2006, according to a report in the Journal of the American Medical Association this week.

But this rapid increase has occurred despite limited data on outcomes and greater costs compared with the “gold standard” conventional procedure.

Dr. Jim C. Hu, from Brigham and Women’s Hospital, Boston, and colleagues compared the outcomes of 1,938 men with prostate cancer who had the keyhole surgery and 6,899 men with prostate cancer who had the conventional surgery.

Compared with men who had the conventional open surgery, men who had the keyhole surgery left the hospital sooner, were also less likely to need blood transfusions and were at lower risk of post-surgery respiratory complications and miscellaneous surgical complications.

However, men who had the keyhole surgery were far more likely than those who had the traditional surgery to suffer incontinence and erectile dysfunction.

It’s also interesting, the researchers say, that men who had the newer high-tech procedure were more likely to live in regions with higher educational levels and incomes compared with men who underwent the older procedure.

In light of the mixed outcomes associated with the newer keyhole surgery, “our finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard may be a reflection of a society and health care system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realize marketed or potential benefits during early adoption,” the investigators conclude.

SOURCE: Journal of the American Medical Association, October 14, 2009.

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