RRP vs RALP paper published by JAMA

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B&B's World
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Date Joined Mar 2007
Total Posts : 120
   Posted 1/20/2010 2:52 PM (GMT -6)   

Worried Guy said:

And if you decided on surgery...Here is the link comparing Robotic vs open surgery results.
Published in JAMA 2009;302(14):1557-1564.
Medicare linked data from 2003 through 2007. ~ 8900 men with prostate cancer who underwent MIRP (n = 1938) vs RRP (n = 6899). MIRP Minimally Invasive = Robotic RRP = open Retropubic

Robotic had fewer complications, fewer hospital days but higher rates of incontinence and ED.

RickyD said...
I just found this statement by Dr. Joseph Smith at Vanderbilt. This is the Dr. J Smith that Dr. Jiminez referred.

"I almost exclusively do robotic prostatectomy now because I think that, despite this manuscript, there is clear evidence that it is comparable, in terms of continence, potency and tumor control,” said Dr. Joseph Smith, the chairman of urologic surgery at Vanderbilt University School of Medicine.

This is from the following article:  http://www.nytimes.com/2009/10/14/health/research/14prostate.html


After reading the above posts, I emailed Dr. Thomas Ahlering, head of Urology at the University of California, Irvine (where the machine was developed), and who performed the Robotic Assisted Laparoscopic Prostatectomy on my husband. I asked his opinion of the study.  He gave me permission to quote his reply:

"As far as the article in NY times which was actually published in JAMA – it did not deserve to be published.  Too many protocol abnormalities and violations.  Simply put, it is just not believable that a procedure can meet all of the early critical landmarks to prove superiority and then at 18 months flip-flop.  There is no question that when the study is done correctly there is a huge advantage to robotics assuming a well trained and dedicated surgeon"



Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

1 1/2 yr PSA  non-existent

Erectile function--up and running!

Two year anniversary on 2/27/09-Sex life back to normal!

Three year anniversary coming up-PSA non-existent on 1/5/10!


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