Role of radical prostatectomy in the treatment of prostate cancer confined to prostate gland. Reality and myth, truth and fiction about robotic assisted radical prostatectomy
Authors:
D. Pacík
Authors‘ workplace:
Urologická klinika FN Brno
Published in:
Urol List 2009; 7(3): 5-14
Overview
Without the possibility of prostate cancer primary prevention we are left with the strategy of secondary prevention – to diagnose the disease early, when it is confined to the prostatic capsule, and cure it only in patients who need it. Radical prostatectomy in present remains the best available modality for early treatment of prostate cancer. Since new so-called less invasive methods (laparoscopic and robotic-assisted) challenge the standard open surgery, the issue of which of these techniques achieves better results, is being frequently discussed. Because of the high purchase cost of these technologies such debates are often blurred with marketing strategies. We have to reject such tendencies and concentrate only on objective evidence-based medicine (EBM) data. The author discusses outcomes and drawbacks of individual techniques and shows that there is currently no evidence supporting any benefit of robotic-assisted radical prostatectomy in terms of invasiveness, recovery and maintaining of urinary continence and erection. The results of these less invasive techniques in terms of oncologic outcome ere even worse – they are associated with higher incidence of so-called positive surgical margins. Surveys show 4,4times higher satisfaction rate in patients undergoing open surgery than in patients treated with robotic-assisted surgery. The adjuvant therapy was more (3,5times) frequently required in patients undergoing robotic-assisted surgery than in the other group.
Key words:
radical prostatectomy, open surgery, robotic assisted surgery
Sources
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Labels
Paediatric urologist UrologyArticle was published in
Urological Journal
2009 Issue 3
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