When it comes to prostate cancer surgery, are best results achieved with open surgery or with minimally-invasive procedures? Alan W. Partin, M.D., Ph.D., a world-renowned expert in the study and treatment of prostate cancer, addresses this important question in an excerpt from our Special Report, Choosing the Right Treatment for Prostate Cancer.
There are three ways to remove the prostate: One is the traditional operation through an open incision, while the others involve a laparoscope or robot. Here is the bottom line: It's the same operation done three different ways. To date, there has been no single randomized study to fully evaluate the key issues.
Our Hopkins experts have looked at all of the critical variables regarding the different surgical approaches, including blood loss, need for transfusion, pain, erectile dysfunction (ED), cancer cure, side effects related to the surgery, and return to work. We found no differences.
How can you counsel a man to look at all of the options for prostate cancer therapy when robotic surgery is so heavily marketed as the best choice?
It's not hard. I sit down with the patient and explain the marketing and advertising behind robotic prostate procedures and how they often help sway patient decisions. I also explain the fact that right here at Hopkins, where we are on the front lines in prostate cancer treatment, there does not appear to be any difference between the open and robotic procedures.
Speaking for the Hopkins surgeons who perform both open and robotic prostatectomies, we don't care which procedure a patient ultimately picks. For us, it's a matter of going to Room 6 or Room 18 to do the prostate surgery. One operation takes a little over an hour to perform the other a little over two and a half hours. The end results are similar.
Some surgeons advertise the fact that they can do a robotic assisted prostatectomy in 90 minutes. Is that possible?
If a surgeon says the procedure takes 90 minutes, then it comes down to the definition of "surgery." These surgeons are only counting the time that they are sitting at the robotic console and operating on the patient. However, at Hopkins we start the clock when the patient is first wheeled into surgery and stop it when he arrives in the recovery room. This takes into account all the extra set-up time necessary to prepare the patient for surgery, and not just the time the doctor spends actually removing the prostate.
How can a man choose between a surgeon who performs the open procedure and one who uses a robot or laparoscope?
Here is what I tell all prospective patients: You don't want to bring a plumber into your home to do electrical work. If your surgeon says he feels confident that he is going to provide the best operation for you with a certain technique -- open, laparoscopic, or robotic -- and you like that surgeon, you should choose him for your surgery.
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey: