Robotic Surgery for Prostate Cancer May Not Improve Quality of Life

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Sexual function scores do not appear to differ between the 2 groups at 6 weeks or 12 weeks post-surgery.
Sexual function scores do not appear to differ between the 2 groups at 6 weeks or 12 weeks post-surgery.

Clinicians and patients in the United States believe that robotic-assisted prostatectomy may yield better clinical outcomes, though the first head-to-head study to compare robotic to non-robotic surgery for prostate cancer suggests otherwise. The study, published in The Lancet, found that the techniques achieve similar outcomes, with no statistical difference in quality of life outcomes between the 2 groups at 12 weeks' follow-up.1

Long-term follow-up of this 2-year, phase 2 study will fully assess the outcomes of both techniques and examine survival. Since the use of robot-assisted laparoscopic prostatectomy (RALP) was first reported in 2000, there has been rapid adoption of robotic surgery prostate cancer.

“We undertook a randomized controlled study of robotic and open prostatectomy to determine whether 1 approach yielded better results than the other at 12 weeks and 24 months after surgery, with respect to the quality of life outcomes of urinary, sexual and bowel function, return to usual activities, and oncological outcomes. There was no significant statistical difference between the robotic and open surgical approach for these parameters at the early time-point of 12 week follow-up,” said study co-author Robert ‘Frank' Gardiner, of the University of Queensland and the Royal Brisbane & Women's Hospital in Australia.

According to Dr Gardiner, the findings were surprising. Pain was measured postoperatively with the Surgical Pain Scale at 24 hours, 1 week, 6 weeks, and 12 weeks. It was found, however, that for pain at rest, no significant differences were noted between the trial groups at any time-point.

“We expected improved short-term (6 weeks and 12 weeks) quality of life outcomes for robotic prostatectomy in terms of urinary, sexual and bowel function, health-related quality of life, pain, and time of return to ‘usual activities.' These expectations were based on our impressions from patient observations and published medical literature,” Dr Gardiner told Cancer Therapy Advisor. “Until more data are published after the 24 month follow-up, patients should choose a surgeon with whom they relate well, rather than 1 or other surgical approach.”

For the present study, 308 men with prostate cancer were enrolled and randomly assigned to receive robot-assisted surgery (157 patients) or radical retropubic prostatectomy (151 patients). Operations were led by 2 surgeons at the Royal Brisbane & Women's Hospital. Men between the ages of 35 years and 70 years were included in the study; the mean age was approximately 60 years.

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