Conflicting robotic prostatectomy studies underscore robotics debate

Urologists attending localized prostate cancer sessions at the upcoming AUA annual meeting in Washington will hear more about the ongoing debate on open versus minimally invasive radical prostatectomy, the use of 5-alpha-reductase inhibitors (5-ARIs) in men on active surveillance, and updates on treatment approaches such as high-intensity focused ultrasound.

Key Points

In the case of prostatectomy techniques, researchers arrived at conflicting findings, said Dr. Gomella, professor and chairman of urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia. One large review including more than 110,000 patients found a lower complication rate among patients undergoing robotic RP compared with the open technique, as well as overall lower perioperative morbidity and improved early oncologic outcomes.

"This is based on a literature review and not on actual discharge records, leading to a potential publication bias toward more favorable outcome reporting," Dr. Gomella said of the study.

A Brazilian prospective trial pronounced robot-assisted laparoscopic RP a safe technique, with lower blood loss and more favorable International Index of Erectile Function scores than seen with the open (retropubic) approach.

"This is a unique prospective trial that will yield important data," Dr. Gomella predicted. "It is unlikely that a similar prospective randomized clinical trial could be completed in the U.S. due to the strong patient preference for robotically assisted radical prostatectomy."