Mixed outcomes after robotic prostatectomy for large prostates
MedWire News: Men who undergo robotic radical prostatectomy (RRP) for prostate cancer experience mixed intraoperative and pathologic outcomes depending on their prostate size, say researchers.
Those with large prostates endure longer operative times and a delayed urinary recovery, but also have more favorable Gleason scores and less positive surgical margins than men with small prostates, the study shows.
"Patients electing robotic prostatectomy may have higher expectations for this innovative approach compared with open surgery," say Brent Hollenbeck (University of Michigan Health System, Ann Arbor) and colleagues.
However, these expectations may be unwarranted in men with larger prostates because of the technical challenges posed, they add, in the journal Urology.
The team investigated whether the advantages of robotic over open surgery - such as stereoscopic visualization - would mitigate some of the challenges presented by a large prostate, including reduced mobility in the pelvis and impaired visualization.
The cohort of 885 RRP patients were divided into three groups based on prostate weight: under 50 g, 50-100 g, and above 100 g. Surgical outcomes were evaluated, and the men completed the Expanded Prostate Cancer Index Composite (EPIC) to measure urinary and sexual functioning 3 months postoperatively.
Increasing prostate size was associated with greater intraoperative blood loss, at 250 versus 155 ml for the greatest versus the smallest prostate groups. Operative time was also longer among men in the largest prostate group compared with the smallest, at 250 versus 232 minutes.
Despite this, patients with the largest prostates also had more postsurgery favorable Gleason scores than those with the smallest prostates, with a respective 47.6% versus 22.0% having a Gleason score 6 or less.
Furthermore, none of the men with prostates weighing over 100 g (n=24) had positive surgical margins after surgery.
However, at the postsurgery follow-up, EPIC scores for urinary continence were significantly lower in men with prostates over 100 g compared with those with prostates under 50 g, at 44.0 versus 62.2, respectively, even after adjustment for potentially confounding factors.
The trend was similar but nonsignificant for recovery of sexual function among these men.
"Appropriately setting expectations for patients undergoing robotic prostatectomy may improve their satisfaction and minimize regret with regard to their treatment choice and outcomes," conclude Hollenbeck et al.
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By Sarah Guy