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    Robotic vs. open RP: Better EF recovery seen with robot

    But open procedure shows lower rate of positive surgical margins in pT2 disease

     

    Extent, location of PSM not included

    Because the study is not a randomized controlled trial, it has the expected weaknesses of an observational study, many of which are partially mitigated due to the circumstantial assignment of the surgical approach. The extent and location of PSM is an important variable that is missing from the report. Unlike a single-center study, the large number of surgeons attempting to consistently replicate a certain dissection technique seems quite improbable.

    However, the inherent variability among surgeons may also make this data more applicable to the general population. The somewhat “captured” nature of the cohort in the Swedish national health care system resulted in a very high follow-up response rate of over 90%. Further, the collection of data by a third-party and patient-reported erectile function provides additional validity to the data.

    Read: Antiandrogen’s role may extend to non-metastatic CRPC

    The apparently mixed report on outcomes between RALP and RRP may at first seem to offset each other, but it’s important to look at the functional outcomes and oncologic control in the proper context. The PSM is only a surrogate of oncologic control and in pT2 disease appears to be less clinically relevant than the ability to preserve or recover erectile function. There is clearly a negative clinical impact of PSM in pT3 disease in terms of recurrence and need for additional treatment. RALP seems to provide better cancer control in these men, with somewhat comparable recovery of potency.

    A thoughtful discussion of the tradeoffs and the importance of oncologic and functional aspects of the outcomes is required on an individual basis.

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