Comparing Prostate Cancer Treatment Options: Which Prostatectomy is Best for You?

A prostatectomy or removal of the prostate gland is generally considered the gold standard treatment option for most men diagnosed with high-risk prostate cancer. Surgical treatment options for removal of the prostate include:

  • Robot-assisted laparoscopic radical prostatectomy
  • Laparoscopic radical prostatectomy
  • Open radical prostatectomy

Outcomes and recovery for each of these treatment options vary. In this article, we will explore the differences between these different surgeries.

Robot-assisted surgery using the daVinci surgical system is a sophisticated, minimally invasive approach that uses advanced technology to help our surgeons perform surgery with greater precision and enhanced dexterity than open or laparoscopic surgery allows. This three-dimensional, high-definition, high-magnification system incorporates the best techniques of open surgery and applies them to a laparoscopic, robot-assisted procedure. This state-of-the-art technology expands the surgeon’s visibility and provides a range of motion that is superior to the range of motion in the human wrist. This type of surgery is performed through five small keyhole incisions, rather than the single large incision made during a traditional open prostatectomy. A miniature camera is used that magnifies the image on a video monitor in the operating room.

Laparoscopic surgery is performed through five small keyhole incisions, rather than the single large incision made during a traditional open prostatectomy. A miniature camera is used that magnifies the image on a video monitor in the operating room.

Open surgery is performed with one large incision between five to eight inches long. Unlike robotic and laparoscopic surgery, no camera or monitors are used. The surgeon is able to perform surgery visualizing with his eyes only. 

There are some considerations when comparing the benefits of robotic, open and laparoscopic surgical approaches.

The risk of complications during and after surgery are lower for men that have robotic surgery when compared to open surgery. Additionally, bleeding and the need for a blood transfusion are much higher for those undergoing open surgery than with the robotic equivalent. The reported blood loss for open prostatectomy surgery averages 800-1000 mL compared to robotic surgery, in which less than two percent of patients require a blood transfusion. 

Research shows decreased rates of positive surgical margins for some types of tumors depend on the surgical approach. Positive surgical margins mean there are cancer cells that extend to the edge of the removed tissue. Negative surgical margins mean there are no cancer cells at the edge of the removed tissues and represents the best clinical picture for cancer control. The highest number of positive surgical margins were seen in open prostatectomy at 23.5 percent, compared to 19.6 percent for laparoscopic prostatectomy, with the lowest risk of positive surgical margins with robotic prostatectomy, at 12.5 percent.  

Following the operation, recovery time in the hospital is shorter for those who have robotic surgery compared to those who have open and laparoscopic. The reported length of stay in the hospital for robotic surgery is 1.9 days.  At The Miriam Hospital, men who have a robotic prostatectomy spend an average of 1.3 days in the hospital. The reported length of stay for open surgery is 3.16 days.

Recovery after surgery also differs by surgical approach. There is improvement in urinary control or continence, for those who have the robotic approach compared to open and laparoscopic prostatectomy. Another benefit of robotic prostatectomy is the improvement in the return of sexual function one year following surgery, compared to the sexual function of those who undergo open prostatectomy.  

Surgeon experience and hospital volume also relate to outcomes. Hospitals that perform a high volume of robotic prostatectomy surgeries have improved outcomes. As pioneers in robot-assisted surgery, The Miriam Hospital was the first hospital in Rhode Island and Southern New England to perform a robot-assisted procedure. Since 2006, we have performed over 2,000 urologic robot-assisted surgeries, with the majority being robotic prostatectomy surgeries, making the Minimally Invasive Urology Institute one of the busiest programs in New England. As faculty at the Warren Alpert Medical School of Brown University, our surgeons have trained many of the local urologists performing robotic surgeries in our region.

For more information or to make an appointment with one of our robotic surgeons, call 401-793-5400 or email MIUItmh@lifespan.org.  

References

Gershman B, Meier SK, Jeffery MM, Moreira DM, Tollefson MK, Kim SP, Karnes RJ, Shah ND.  Redefining and contextualizing the hospital volume-outcome relationship for robot-assisted radical prostatectomy: implications for centralization of care. The Journal of Urology 2017;198,1, 92-99.

Liu JJ, Maxwell BG, Panousis P, Chung BI.  Perioperative outcomes for laparoscopic and robotic compared with open prostatectomy using the national surgical quality improvement program (NSQUIP) database.  Urology 2013;83,3, 579-583. 

Novara G, Ficarra V, Rosen RC, et al.  Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy.  European Urology 2012;62, 431-452.

Edmund L, Rotker KL, Lakis NS, Brito JM, Lepe M, Lombardo KA, Renzulli JF, Matoso A.  Upgrading and upstaging at radical prostatectomy in the post-prostate-specific antigen screening era: an effect of delayed diagnosis or a shift in patient selection?  Human Pathology 2017;59, 87-93.

Moran PS, Oneill M, Teljeur C, Flattery M, Murphy LA, Smyth G, Ryan M.  Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: a systematic review and meta-analysis.  International Journal of Urology 2013;20, 312-321.

Maddox M, Lasser M, Renzulli JF, Haleblian G, Pareek G.  An updated report on complications following robotic prostatectomy: results of an unbiased prospective database.  Journal of Endourology 2013;27,5, 554-559.

Lasser MS, Renzulli JF, Turini GA, Haleblian G, Sax HS, Pareek G.  An unbiased prospective report of perioperative complications of robot-assisted laparoscopic radical prostatectomy. Urology 2010;75,5, 1083-1089.