Side effects of prostate removal not improved by robotic surgery

Robot-assisted surgery for localised prostate cancer does not offer any benefits to urinary and sexual function compared to open surgery after 12 weeks, according to new results from a clinical trial in Australia.

The trial compared outcomes from men treated by two surgeons. One performed keyhole surgery using robotic arms, and the other performed open surgery that involves a cut across the stomach area. However, as all of the surgeries were carried out by two surgeons, we can’t tell what effect the surgeons’ experience might have had.

It’s important to bear in mind that keyhole surgery can be also performed by hand, and this is more common than open surgery in the UK. However, this type of surgery was not included in the study.

These early results – based on questionnaires completed by 252 men who were randomly assigned to one of the two surgeries – revealed that there were no differences in urinary continence and erectile function, which were the main outcomes studied. However, these can improve over three years following any surgery, so differences may only become apparent later. Men who received robotic surgery spent half as long in hospital and had less pain in the week after surgery but this did not help them to return to work any earlier.

Ultimately the researchers are interested in the long-term benefits of each type of surgery and will check the progress of the trial participants after two years. This will help them to assess the effect on survival and recurrence, as well as long term differences in side effects. They concluded that they would “encourage patients to choose an experienced surgeon they trust and with whom they have rapport, rather than choose a specific surgical approach.”

Simon Grieveson, our Head of Research Funding, said: “The vast majority of men who opt to have their prostate removed have key hole surgery, either performed using robotics or by hand, with only 13% of cases undergoing  open surgery. However, there is scarce evidence comparing the three different types of treatment.

“We look forward to future results of this study, but in the meantime it is crucial that any man undergoing surgery for prostate cancer is made aware of all the options available to him and makes an informed choice.”

Robot-assisted surgery was first reported in 2000 and has become popular with doctors and patients alike. It now accounts for more than half of all prostate surgeries in the UK, despite the additional cost of the robot.

We don’t think there is enough good evidence yet to show that robotic surgery to remove the prostate is any more beneficial than conventional keyhole surgery that is carried out by hand. This study didn’t compare these two surgeries, so doesn’t change our position on this.