Prostate cancer treatments are contrasted

Many patients perceive minimally invasive surgery as the better choice over open surgical procedures; however, up to this point, little data were available about utilization and outcomes of minimally invasive radial prostatectomy (MIRP) to treat prostate cancer compared with the older open radical prostatectomy approach.

Jim Hu and colleagues at Harvard-affiliated Brigham and Women’s Hospital (BWH) assessed surgical utilization and complications, lengths of hospital stay, and cancer outcomes in more than 2,700 men who underwent prostate cancer surgery. The researchers found that MIRP usage almost tripled between 2003 and 2005 — a striking finding since the procedure was introduced in the United States in 2000. Additionally, the researchers found that although MIRP patients had fewer surgical complications and shorter hospital stays by almost three days, they were more likely to require additional cancer treatments after surgery compared with men undergoing open surgery. These findings appear in the May 10 issue of the Journal of Clinical Oncology.

“In short time, MIRP has taken over as one of the most popular treatments for prostate cancer, but one cannot help but think this procedure was adopted by surgeons too quickly because cancer outcomes for MIRP patients overall were not as favorable as those who underwent open radical prostatectomy,” said lead author Hu. “However, the results of our national study differ from outcomes at high-volume centers where cancer control for the open and minimally invasive approaches are very similar.”

The researchers found that experienced or high-volume MIRP surgeons were more likely to have favorable cancer outcomes compared with low-volume MIRP surgeons, suggesting that the rapid adoption of the procedure by eager surgeons, not the procedure itself, is a possible cause for worse long-term outcomes compared with open radical prostatectomy.

“There is a steep learning curve for MIRP, and based on our research, I would tell patients deciding on a prostate cancer treatment to pay attention to the experience of their doctor and not be seduced by the smaller incisions and newer technologies offered by minimally invasive surgery,” Hu added.