The Comparative Harms of Open and Robotic Prostatectomy in Population-Based Samples.

Robotic assisted radical prostatectomy (RALP) has largely replaced open radical prostatectomy (RRP) for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to either disease control or functional sequelae.

This study, using population cohort data, examined sexual and urinary function between men undergoing RRP versus those undergoing RALP.

Subjects surgically treated for prostate cancer were selected from two large population-based prospective cohort studies, the Prostate Cancer Outcomes Study (PCOS; enrolled 1994-95) and the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR; enrolled 2011-2012). Subjects completed baseline, 6 and 12 month standardized patient-reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression and adjusting for baseline function, sociodemographic, and clinical characteristics. Sensitivity analyses evaluated outcomes between patients undergoing RRP and RALP within and across CEASAR and PCOS studies.

The combined cohort consisted of 2438 men, 1505 of whom underwent RRP and 933 of whom underwent RALP. Men undergoing RALP reported better urinary function at 6 months (mean difference 3. 77 points, 95% CI 1. 09 to 6. 44) but not at 12 months (1. 19, -1. 32 to 3. 71). Subjects undergoing RALP also reported superior sexual function at 6 months (8. 31, 6. 02 to 10. 56) and 12 months (7. 64, 5. 25 to 10. 03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results.

This population-based study reveals that men undergoing RALP likely experience less decline in early urinary continence and sexual function compared to those undergoing RRP. The clinical meaning of these differences is uncertain and longer follow-up will be required to establish whether these benefits are durable.

The Journal of urology. 2015 Sep 03 [Epub ahead of print]

Brock O'Neil, Tatsuki Koyama, JoAnn Alvarez, Ralph M Conwill, Peter C Albertsen, Matthew R Cooperberg, Michael Goodman, Sheldon Greenfield, Ann S Hamilton, Karen E Hoffman, Richard M Hoffman, Sherrie H Kaplan, Janet L Stanford, Antoinette M Stroup, Lisa E Paddock, Xiao-Cheng Wu, Robert A Stephenson, Matthew J Resnick, Daniel A Barocas, David F Penson

Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA. Department of Biostatistics, Vanderbilt University, Nashville, TN, USA. , Department of Biostatistics, Vanderbilt University, Nashville, TN, USA. , CEASAR Patient Advocacy Network. , Division of Urology, University of Connecticut Health Center, Farmington, CT, USA. , Department of Urology, University of California San Francisco, San Francisco, CA, USA. , Department of Epidemiology, Emory University, Atlanta, GA, USA. , Department of Medicine, University of California, Irvine, Irvine, CA, USA. , Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. , Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. , Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. , Department of Medicine, University of California, Irvine, Irvine, CA, USA. , Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. , New Jersey State Cancer Registry, Trenton, NJ, USA. , New Jersey State Cancer Registry, Trenton, NJ, USA. , Louisiana State University Health Sciences Center, New Orleans, LA, USA. , Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA. , Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA. , Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA. , Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.

PubMed

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