Although robotic-assisted laparoscopic radical prostatectomy “is eclipsing open radical prostatectomy among men with clinically localized prostate cancer,” the risks of problems with sexual functioning and continence are no lower with robotic than open surgery, according to a study in the Journal of Clinical Oncology. The study compared continence and sexual function among a random sample of Medicare enrollees who had hospital and physician claims for radical prostatectomy and diagnostic codes for prostate cancer, and reported receiving treatment with either robotic-assisted laparoscopic radical prostatectomy or open retropubic radical prostatectomy.
Surveys mailed to the men included self-ratings for problems related to continence and sexual function at a median of 14 months postoperatively. “The main focus of this survey was the quality of the decision-making process leading to surgery, but items related to bother of adverse effects were also included,” the investigators noted. “For the analyses in this article, the two key outcome questions were ‘Since this prostate surgery, how much of a problem have you had with leaking or dripping urine?’ and ‘Since this prostate surgery, how much of a problem have you had with sexual functioning, such as problems with erections?’ Possible responses,” the investigators explained, “were ‘No problem,’ ‘A very small problem,’ ‘A small problem,’ ‘A moderate problem,’ and ‘A big problem.’”
Surveys were returned by 685 men, but some did not answer all of the questions. The final sample size was 406 men assumed to have had the robotic-assisted laparoscopic procedure and 220 assumed to have had open surgery. Overall, 189 (31.1%) of 607 men reported having a moderate or big problem with continence, and 522 (88.0%) of 593 men reported having a moderate or big problem with sexual function. “In logistic regression models predicting the log odds of a moderate or big problem with postoperative continence and adjusting for age and educational level, robotic prostatectomy was associated with a nonsignificant trend toward greater problems with continence,” the investigators reported. “Robotic prostatectomy was not associated with greater problems with sexual function,” they added.
“Medicare-age men with clinically localized prostate cancer should understand that risks of problems with continence and sexual function remain high in the recent national surgical experience regardless of whether they choose [robotic or open prostatectomy], and they should not be led to expect fewer bothersome adverse effects following [robotic-assisted surgery],” the researchers concluded. “The apparent lack of better outcomes associated with [robotic-assisted surgery] also calls into question whether Medicare should pay more for this procedure until prospective large-scale outcome studies from the typical sites performing these procedures demonstrate better results in terms of adverse effects and cancer control.” ■
Barry MJ, et al: J Clin Oncol. January 3, 2012 (early release online).