NEW YORK (Reuters Health) Jan 09 - In a recent survey, men who had robotic surgery for prostate cancer and men who had lower-tech surgeries were equally likely to have sexual problems and urinary leakage afterward.
"I wasn't surprised at all," said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who wasn't involved in the study.
"Unfortunately, robotic prostatectomy -- like many things in prostate cancer -- has gotten a lot more hype than it should."
Robotic prostatectomy has caught on rapidly in the U.S., despite the fact that there isn't enough data to prove it's better than traditional approaches. It is, however, much more costly, adding some $2,000 in hospital costs per procedure.
The new study, published online January 3 in the Journal of Clinical Oncology, is based on responses from more than 600 prostate cancer patients on Medicare, including roughly 400 who had robotic-assisted laparoscopic prostatectomy.
Nearly 90% had a moderate or major problem with sexual functioning 14 months after their surgery, Dr. Michael Barry of Massachusetts General Hospital in Boston and colleagues found. And about 33% reported incontinence afterward.
Overall, there were no differences between the two patient groups, although urinary problems appeared to be slightly more common after the robot procedure.
An editorial in the journal called the findings "sobering" but added that it's hard to compare the two procedures directly based on the survey results. It's possible, for instance, that men with high hopes for the robot procedure would be particularly bothered by side effects afterward.
"The problem that is revealed in this paper is this question of expectations," said Dr. Matthew Cooperberg, a urologist who co-wrote the editorial. "There is a known issue of regret related to robotic surgery."
Part of the problem is heavy promotion, which has catapulted robot surgery to its current status. Out of the tens of thousands prostate removals done annually in the US, some 85% are estimated to be robotic.
"To an extent it's the manufacturer, to an extent it's surgeons, to an extent it's a culture that tends to put great faith in technology, even when the patient doesn't understand it," Dr. Cooperberg, of the University of California, San Francisco, told Reuters Health.
The robots, which cost a couple of million dollars each, do have some advantages, such as less blood loss. But Dr. Cooperberg, who uses the technology himself, readily acknowledges that it probably doesn't treat cancer any better than the old surgery and doesn't have proven benefit in terms of side effects.
SOURCES: http://bit.ly/wf5iCM and http://bit.ly/wf5iCM
J Clin Oncol 2012.
"I wasn't surprised at all," said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who wasn't involved in the study.
"Unfortunately, robotic prostatectomy -- like many things in prostate cancer -- has gotten a lot more hype than it should."
Robotic prostatectomy has caught on rapidly in the U.S., despite the fact that there isn't enough data to prove it's better than traditional approaches. It is, however, much more costly, adding some $2,000 in hospital costs per procedure.
The new study, published online January 3 in the Journal of Clinical Oncology, is based on responses from more than 600 prostate cancer patients on Medicare, including roughly 400 who had robotic-assisted laparoscopic prostatectomy.
Nearly 90% had a moderate or major problem with sexual functioning 14 months after their surgery, Dr. Michael Barry of Massachusetts General Hospital in Boston and colleagues found. And about 33% reported incontinence afterward.
Overall, there were no differences between the two patient groups, although urinary problems appeared to be slightly more common after the robot procedure.
An editorial in the journal called the findings "sobering" but added that it's hard to compare the two procedures directly based on the survey results. It's possible, for instance, that men with high hopes for the robot procedure would be particularly bothered by side effects afterward.
"The problem that is revealed in this paper is this question of expectations," said Dr. Matthew Cooperberg, a urologist who co-wrote the editorial. "There is a known issue of regret related to robotic surgery."
Part of the problem is heavy promotion, which has catapulted robot surgery to its current status. Out of the tens of thousands prostate removals done annually in the US, some 85% are estimated to be robotic.
"To an extent it's the manufacturer, to an extent it's surgeons, to an extent it's a culture that tends to put great faith in technology, even when the patient doesn't understand it," Dr. Cooperberg, of the University of California, San Francisco, told Reuters Health.
The robots, which cost a couple of million dollars each, do have some advantages, such as less blood loss. But Dr. Cooperberg, who uses the technology himself, readily acknowledges that it probably doesn't treat cancer any better than the old surgery and doesn't have proven benefit in terms of side effects.
SOURCES: http://bit.ly/wf5iCM and http://bit.ly/wf5iCM
J Clin Oncol 2012.
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