Robotic Prostatectomy Vs. Radiation

Robotic Prostatectomy Vs. Radiation

Robotic Prostatectomy Vs. Radiation

For men diagnosed with prostate cancer, deciding on whether to opt for radiation treatment or have their prostate gland surgically removed can be difficult. Surgery to remove the prostate gland (radical prostatectomy) and radiation therapy are two of the most commonly elected treatments for prostate cancer. Both treatment options are associated with a variety of potential complications and side effects but robotic prostatectomy has a host of benefits with far fewer side effects associated with radiation therapy.

Treatments

Da Vinci Robotic Prostatectomy/Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP)

The surgery is performed by a trained and skilled surgeon through the use of a computer-enhanced robotic surgical system. Instead of the large incision used in open surgery, da Vinci surgeons make just a few small incisions – similar to traditional laparoscopy. The da Vinci System also features a magnified 3D high-definition vision system and special wristed instruments which precisely translates the hand movements of the surgeon.

Pros:

  • Proven to reduce prostate cancer death rates
  • PSA levels help to reliably predict possible recurrences
  • Little to no blood loss
  • Less pain
  • Shorter recovery times
  • Shorter hospitalization (1-2 days)
  • Catheter removed in just 5-7 days
  • More maneuverability and precision for the robotic surgeon
  • More visibility of prostate and surrounding tissue/organs
  • Prostate cancer is removed with a higher cancer cure rate when performed by a skilled robotic surgeon

Cons:

  • Possible erectile and urinary side effects post surgery when procedure is performed by a less-skilled and inexperienced surgeon

Radiation Treatments

Brachytherapy (Internal Radiation Therapy) – This procedure involves making an incision under general anesthesia to implant pellets into the prostate gland that release low doses of radiation slowly over a period of months. About 40 to 150 rice-size seeds are implanted, and they lose their radioactivity over the course of a year.

Side effects/cons:

  • Pain or swelling in the area between anus and scrotum for some time after treatment
  • May be forced to stay away from children and pregnant women due to the internal radiation
  • May be forced to strain urine in case of pellets moving
  • Can cause bowel, urinary, and erectile issues
  • No staging information after treatment

External Beam Radiation Therapy (EBRT) – The prostate gland is targeted with beams of radiation (X-rays or Proton) from outside the body . It typically consists of five treatments a week over the course of an eight-week period and can last 15 to 25 minutes to complete without the need for anesthesia.

Side effects/cons:

  • Increased tiredness or fatigue due to radiation
  • Requires frequent treatments (up to 5 days a week for about 7 to 9 weeks)
  • Can cause rectal soreness
  • Higher probability of developing erectile dysfunction, bladder, or urinary problems (radiation cystitis, incontinence) that can worsen over time
  • Can cause bowel problems due to radiation (radiation proctitis)
  • No staging information after treatment

Outcome Comparison

Outcome

Radical Prostatectomy

Radiation

Survival duration compared to conservative disease management8.6 years4.6 years
15-year prostate cancer survival rate92%87%
Disease-specific long-term quality of lifeStableUnstable
Painful urination (at 24 month follow-up)2.1% of patients19% of patients

A past study in the Lancet Oncology Journal also showed that radiation therapy complication rates were 2- to 10-times higher than complication rates in men who were treated with robotic prostatectomy. The most decisive plan of attack for localized prostate cancer is surgery. For most men anything else, including radiation, is less targeted, less effective, and less definitive.

Surgically removing the entire prostate also allows for more accurate staging and grading. This allows your doctor to create a better long-term plan of care. Radiation can however still serve as an option for patients following surgery to further treat prostate cancer if more treatment is required.