Prostate Cancer Treatment
Comparison
TreatmentComparative Data
*Open surgery; comparable long-term data not yet available on da Vinci庐Prostatectomy.
**External Beam Radiation Therapy (EBRT) unless otherwise noted in the citation.
Outcome
Radical Prostatectomy*
Radiation**
Survival duration compared to conservative
disease management1
8.6 years
4.6 years
15-year prostate cancer survival rate2
92%
87%
Survival rate for high-grade cancer patients3
45% increase in overall survival
rate vs. radiotherapy
-
Risk of cancer-specific death for
high-grade cancer patients4
49% less risk vs. radiotherapy
-
Cancer recurrence5
Easy to detect
Difficult to detect
Risk of rectal cancer
(Within 10 year follow-up) 6
5.1 out of 1000
10.0 out of 1000
Risk of bladder cancer7
0.8% developed bladder cancer
1.3% developed bladder cancer
Bowel function impairment8
-
Significantly greater vs. surgery
Disease-specific long-term quality of life9
Stable
Unstable
Painful urination (at 18 month follow-up) 10
1% of patients
30% of patients
Long-term erectile dysfunction11
Lower risk
Higher risk
Outcome Comparison: Surgery vs. Radiotherapy
References for previous slide
[1] Tewari A, Raman JD, Chang P, RaoS, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer
treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74.
[2] Tewari A, Raman JD, Chang P, RaoS, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer
treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74.
[3] Tewari A, Divine G, Chang P, ShemtovMM, MilowskyM, NanusD, Menon M. Long-term survival in men with high grade prostate cancer: a
comparison between conservative treatment, radiation therapy andradical prostatectomy--a propensity scoring approach. J Urol. 2007
Mar;177(3):911-5. Erratum in: J Urol. 2007 May;177(5):1958.
[4] Tewari A, Divine G, Chang P, ShemtovMM, MilowskyM, NanusD, Menon M. Long-term survival in men with high grade prostate cancer: a
comparison between conservative treatment, radiation therapy andradical prostatectomy--a propensity scoring approach. J Urol. 2007
Mar;177(3):911-5. Erratum in: J Urol. 2007 May;177(5):1958.
[5] DiBlasio, C. J., A. C. Rhee, et al. (2003). Predicting clinical end points: treatment nomogramsin prostate cancer. SeminOncol30(5): 567-
86.
[6] Baxter NN, TepperJE, Durham SB, RothenbergerDA, VirnigBA. Increased risk of rectal cancer after prostate radiation: apopulation-based
study. Gastroenterology. 2005 Apr;128(4):819-24.
[7] BoorjianS, Cowan JE, KonetyBR, DuChaneJ, Tewari A, Carroll PR, Kane CJ; Cancer of the Prostate Strategic Urologic Research Endeavor
Investigators. Bladder cancer incidence and risk factors in men with prostate cancer: results from Cancer of the Prostate Strategic Urologic
Research Endeavor. J Urol. 2007 Mar;177(3):883-7; discussion 887-8.
[8] LitwinMS, SadetskyN, Pasta DJ, LubeckDP. Bowel function and bother after treatment for early stage prostate cancer: a longitudinal
quality of life analysis from CaPSURE. J Urol. 2004 Aug;172(2):515-9.
[9]Miller, D. C., M. G. Sanda, et al. (2005). Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life
changes after radical prostatectomy, external radiation, and brachytherapy. J Clin Oncol23(12): 2772-80.
[10]Buron, C., B. Le Vu, et al. (2007). Brachytherapyversus prostatectomy in localized prostate cancer: Results of aFrench multicenter
prospective medico-economic study. IntJ RadiatOncolBiolPhys67(3): 812-22.
[11]Di Blasio, C. J., A. C. Rhee, et al. (2003). Predicting clinical end points: treatment nomogramsin prostate cancer. SeminOncol30(5): 567-
86.
TreatmentComparative Data
Outcome
dVP
Open
Lap
Cancer control
T2 margin status
4.51
5.92
7.73
Complications
Estimated blood loss (EBL) 109 ml4
1355 ml5
380 ml6
Length of stay (LOS)
1.2 days4
3 days5
2.5 days13
Major
1.7%4
6.7%5
3.7%6
Minor
3.7%4
12.6%5
14.6%6
Urinary function
3 month
92.9%7
54%8
62%9
6 month
94.9%7
80%8
77%9
12 month
97.4%7
93%8
83%9
Sexual function
12 month
86%10
71%11
76%12
Prostatectomy Outcome Comparison:
da Vinci庐 vs. Open vs. Conventional Laparoscopy
References for previous slide
[1] AhleringTE, Woo D, EichelL, Lee DI, Edwards R, SkareckyDW. Robot-assisted versus open radical prostatectomy: a
comparison of one surgeon's outcomes. Urology. 2004 May;63(5):819-22. p. 821 table III.
[2] ScardinoPT. Open Radical RetropubicProstatectomy. Presented at the American Urological Association's Carcinoma of the
Prostate Course, San Francisco, California, Sept. 30 -Oct. 1 2005
[3] TouijerK, KuroiwaK, SaranchukJW, HassenWA, TrabulsiEJ, Reuter VE, GuillonneauB. Quality improvement in laparoscopic
radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol.
2005 Mar;173(3):765-8. p. 766 (Results)
[4] Bhandari, A., McIntire, L., Kaul, S.A., Hemal, A.K., Peabody, J.O., and Menon, M. (2005). Perioperativecomplications of
robotic radical prostatectomy after the learning curve. J Urol 174 , 915-918.
[5] Brown, J.A., Garlitz, C., Gomella, L.G., McGinnis, D.E., Diamond, S.M., and Strup, S.E. (2004). Perioperativemorbidity of
laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urologic oncology 22 , 102-106.
[6]Guillonneau, B., Rozet, F., Cathelineau, X., Lay, F., Barret, E., Doublet, J.D., Baumert, H., and Vallancien, G. (2002).
Perioperativecomplications of laparoscopic radical prostatectomy: the Montsouris3-year experience. The Journal of urology
167 , 51-56.
[7] Locke, DR, KlimbergIW and Sessions RP. Robotic Radical Prostatectomy With Continence And Potency Sparing Technique: An
Analysi
s Of The First 250 Cases. Submitted To Journal Of Urology, Publication Date TBD. p. 5 table 4.
[8] Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000
Jul;164(1):242. p. 59 table 1.
[9]Goeman, L., Salomon, L., La De Taille, A., Vordos, D., Hoznek, A., Yiou, R., and Abbou, C.C. (2006). Long-term functional and
oncologicalresults after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients.
World J Urol 24 , 281-288.
[10] Kaul, S., Bhandari, A., Hemal, A., Savera, A., Shrivastava, A., and Menon, M. (2005). Robotic radical prostatectomy with
preservation of the prostatic fascia: a feasibility study. Urology 66 , 1261-1265.
[11] Parsons JK, MarschkeP, Maples P, Walsh PC. Effect of methylprednisoloneon return of sexual function after nerve-sparing
radical retropubicprostatectomy. Urology. 2004 Nov;64(5):987-90.
[12] Su, L.M., Link, R.E., Bhayani, S.B., Sullivan, W., and Pavlovich, C.P. (2004). Nerve-sparing laparoscopic radical
prostatectomy: replicating the open surgical technique. Urology 64 , 123
[13] Dahl DM, L'esperanceJO, Trainer AF, JiangZ, Gallagher K, LitwinDE, BluteRD Jr. "Laparoscopic radical prostatectomy:
initial 70 cases at a U.S. university medical center."Urology. 2002 Nov;60(5):859-63.
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