In a nutshell
The authors aimed to determine the benefit of robot-assisted radical prostatectomy (RARP) compared to retro-pubic radical prostatectomy (RRP) in reducing biochemical recurrence in men with prostate cancer.
The authors concluded that RARP compared to RRP improved positive surgical margins (PSM) and biochemical recurrence.
Some background
Prostate surgery is a treatment option used in prostate cancer. It involves the surgical removal of the prostate gland. The are numerous types of surgery. RARP is a relatively new procedure used to surgically remove the prostate gland. This involves keyhole (or multiple small incisions) surgery using robotic assistance to remove the prostate, seminal vesicles (tube-like glands which make semen) and occasionally lymph nodes. RRP is another form of surgery where the prostate gland is removed through a larger incision in the stomach. It is most commonly used in men with early prostate cancer.
Some studies have noted that RARP is associated with improved function after surgery, and improvement in surgical margins. A positive surgical margin (PSM) indicates there are cancer cells remaining around the area where the tumor was removed. RARP has also been associated with lower risk of biochemical recurrence (BCR). A BCR refers to an increase in PSA, or prostate-specific antigen, a protein elevated in the blood during prostate cancer. However, other studies have not found any benefit for RARP compared to RRP. Further studies are needed.
Methods & findings
The aim of this study was to determine the benefit of RARP compared to RRP in reducing PSM and BCR in men with prostate cancer.
908 patients were included in this study and were separated into two groups. The 490 patients in group 1 underwent RRP. The 418 patients in group 2 underwent RARP. PSM was measured based on cancer stage. Localized cancer (stages pT1-pT3a) was confined to the prostate. Advanced cancer (stages pT3b-pT4) had spread through the wall of the prostate into surrounding organs.
The overall PSM rate was 44% in group 1 and 21% in group 2.
In group 1, the PSM rate ranged from 12% in men with pT2a, to 43% in men with pT2c, to 78% in men with pT3a. The PSM rate was 50% in men with pT3b and 40% in men with pT4.
In group 2, the PSM rate ranged from 9.8% to 12% in men with pT2. It was 43% in men with pT3a. The PSM rate was 55% in men with pT3b and 0% in men with pT4.
Group 2 also had a 40% reduced risk of biochemical recurrence.
The bottom line
The authors concluded that RARP improved PSM and biochemical recurrence rates compared to RRP.
The fine print
This study did not compare long-term survival rates. Further studies are needed to examine other outcomes.
Published By :
BMC cancer
Date :
Jun 29, 2017
