New prostate surgeries yield good results, study says

Studies presented recently may help men weigh the risks and benefits of different types of prostate surgery. Prostate cancer patients who opt for surgery instead of radiation or radioactive "seeds" have a range of options.

Traditional prostate surgery, in which doctors wield instruments by hand, has the longest track record for keeping men cancer-free and remains the "gold standard," said Martin Sanda, director of the prostate care center at Boston's Beth Israel Deaconess Medical Center. A growing number of men are attracted to two newer types of surgery performed in the U.S.A. for only about six years, Sanda said.

Laparoscopic operations allow doctors to make several tiny, keyhole incisions, while robotic procedures let surgeons operate with the help of mechanical arms. The newer procedures cause less blood loss than traditional techniques, in which doctors must make incisions big enough to accommodate their hands, Sanda said.

In a study of 575 men presented at a recent meeting of the American Urological Association in Anaheim, Calif., doctors at Eastern Virginia Medical School in Norfolk found little difference in quality of life after any of the three surgeries. After 18 months, about 75 percent of men had the same urinary control as before surgery; 40 percent regained the same level of sexual function.

In a five-year, multi-hospital study of 602 men, Sanda found the newer procedures may be as good as the older surgeries in many ways, especially as doctors get more practice.

Men treated with the newer surgeries had less scarring and pain, the study shows. They recovered control over urination as well as patients who opted for the older procedure. In the first year, however, men who opted for traditional surgery had better sexual function. For men treated in the third year of the study - after surgeons had performed more of the new procedures - sexual function was equally good, no matter which technique men chose, Sanda said.

That suggests that surgeons face a substantial learning curve when tackling complex procedures, he said. In the year before the study, surgeons had performed an average of 79 traditional prostate removals, but only 15 laparoscopic.

Indeed, one of the country's most experienced prostate surgeons, Joseph Smith of Vanderbilt University Medical Center, wrote in a 2005 paper it took him 150 robotic surgeries to achieve the same results as in traditional prostate removal. Smith, who has performed more than 2,500 traditional prostate surgeries and 1,500 robotic ones, said he now uses a robot for about 90 percent of his procedures.

Experts said men must grapple with many unanswered questions when selecting prostate surgery.

Peter Scardino, chairman of surgery at New York's Memorial Sloan-Kettering Cancer Center, notes that doctors don't yet know which technique best cures cancer. The new procedures haven't been around long enough, said Scardino, who was not involved with the new studies.

Sanda notes that he plans to follow the men in his study for 10 years to learn whether one type of surgery prevents relapses better than others.

Men lack another key piece of data, Scardino said. No one has conducted a randomized controlled trial - a type of study considered to be definitive - of all three methods. Such a trial would be daunting, largely because few men would agree to be randomly assigned to a type of surgery, he said. Scardino said many of the articles published present overly sunny pictures of the new procedures. Hospitals are much more likely to trumpet their successes with robots than to admit disappointing results in print.

"I tell patients it's the surgeon that matters, not the tool," Scardino said.