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    Robotic vs. open RP: Experts react to first randomized trial


    In reviewing the paper, Gerald L. Andriole, MD, focused on the oncologic outcomes.

    “That is the reason men choose to undergo surgery for prostate cancer, and as I and many others would have anticipated, open prostatectomy was superior to the robotic technique at achieving negative surgical margins overall and especially for men who had more advanced (≥T3) disease (92% vs. 89%),” he said.

    Also see: Prostate HIFU lands in the U.S. Now what?

    Suggesting that the absence of a statistically significant difference in surgical margin status reflected sample size, Dr. Andriole said the difference is concerning considering that today, more men undergoing prostatectomy have locally advanced tumors.

    “Time will tell, but the higher rate of positive margins with the robotic technique may well be a harbinger of later disease recurrence and the need for additional treatment,” said Dr. Andriole, of Washington University School of Medicine, St. Louis.

    Noting that quality of life and oncologic control are the most important outcomes following radical prostatectomy, Herbert Lepor, MD, highlighted the absence of statistically significant between-group differences in the early sexual and urinary function scores. However, he also cited the 50% increase in positive margin rate in the robotic group as worrisome, and he downplayed the statistically significant differences in pain scores as being clinically insignificant (mean difference of about 1 point on a 10-point scale).

    “The robotic approach must be unequivocally superior to open surgery in order to justify its learning curve and higher cost. We can quibble over details, but this study provides compelling evidence that the robotic approach is clearly not superior. If it was performed a decade ago, payers would not pay for the robot, nor would patients demand the procedure,” said Dr. Lepor, of New York University Langone Medical Center, New York.

    More on Prostate Cancer:

    Prostate biopsy-related infections raise transfusion risk

    Data offer new insight on HIFU’s use in low-risk PCa

    Use of observation for PCa varies widely among urologists

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