Which prostate surgery is best? Depends on the surgeon

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Corbis

The current standard of surgery for prostate cancer patients is what is known as open radical prostatectomy, which involves a surgeon accessing and removing the cancerous prostate gland by making a standard surgical incision. Yet, in recent years, a less invasive approach, known as laparoscopic radical prostatectomy, which often uses robotic assistance, has grown in popularity and is increasingly recommended by medical professionals. Yet, according to a new study published in the Journal of Urology, analyzing safety and success rates by focusing on the procedure itself—and making recommendations to patients based on this approach—may be misguided.

Despite the popular perception that a laparoscopic approach is safest or most successful, when researchers from Memorial Sloan-Kettering Cancer Center analyzed medical records for nearly 6,000 prostate surgery patients ages 66 and older, they found comparable success rates for both open and laparoscopic surgical approaches. The only major differences between surgical techniques were that the less invasive approach was associated with shorter post-operative hospital stays and fewer urinary tract obstructions after surgery. Yet, when surgical outcomes were analyzed not by technique but by surgeon experience, clear trends emerged: as you might expect, surgeons who had performed a particular procedure more often had higher success rates in preventing cancer recurrence and lower levels of complications. Compared with surgeons with the least experience, surgeons with the most experience saw 20% fewer surgical complications. Just 1.8% of urologic surgeons perform more than 50 radical prostatectomies each year; 80% of prostate surgeries are performed by doctors who do 10 or fewer such procedures annually.

These findings emphasize the need for more patient education about all aspects of major surgery, the authors argue. In addition to informing patients about the potential risks and benefits of open versus laparoscopic surgery, they should also be informed about how their surgeon’s experience can impact outcomes, they say. Nearly 200,000 men are diagnosed with prostate cancer each year, and roughly one third of those patients’ treatment includes surgical intervention.

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