Prostate Cancer Control Better with Robot-Assisted Surgery

It is associated with fewer positive surgical margins and reduced need for additional treatment.
It is associated with fewer positive surgical margins and reduced need for additional treatment.

Robot-assisted prostate surgery is associated with improved early cancer control, according to a new study.

In a retrospective population-based study of patients with prostate cancer (PCa), Jim C. Hu, MD, MPH, of the University of California Los Angeles (UCLA), and Maxine Sun, PhD, of the University of Montreal Health Center, used Surveillance Epidemiology and End Results (SEER)-Medicare linked data to study 5,556 men who underwent robot-assisted radical prostatectomy (RARP) and 7,878 who underwent open radical prostatectomy (ORP).

In propensity-adjusted analyses, RARP was associated with a significant 34% and 30% decreased likelihood of positive surgical margins (PSMs) compared with ORP among men with intermediate- and high-risk cancer, respectively.

Additionally, results showed that RARP was associated with a 25%, 27%, and 33% decreased likelihood of requiring additional cancer treatment (androgen deprivation and radiation) within 6, 12, and 24 months, respectively.

Previous research has demonstrated that PSMs are independently associated with higher PCa-specific mortality and with an increased risk of biochemical recurrence, local recurrence, and use of salvage therapy.

The researchers, who published findings online ahead of print in European Urology, concluded that their findings “are particularly policy relevant, as there is greater consensus toward the appropriateness of active surveillance for men who have low-risk PCa, with a resultant shift of RP toward intermediate- and high-risk disease.”

In an interview with Renal & Urology News, Dr. Hu said the study is the first population-based study to demonstrate improved cancer control with robotic prostatectomy. One of the study strengths was that it included community settings and academic centers across the United States with complete follow-up data, he said.

“Open surgeons assert that the absence of tactile feedback during robotics leads to worse cancer control,” said Dr. Hu, director of UCLA's Robotic and Minimally Invasive Surgery Program. “In other words, they claim that during open surgery, the sense of feel allows them to cut wider in areas of suspicion by touch and therefore avoid positive margins and achieve better cancer control. Our observational study does not support this claim.”

The finding of improved early cancer control with RARP comes amid mounting evidence that robotic prostate surgery is associated with better perioperative outcomes, such as less blood loss, shorter hospital stays, and fewer anastomotic strictures. “The key question is whether the higher costs of robotic surgery justify these incremental benefits in outcomes,” Dr. Hu said.

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