Impotence, Incontinence Risk Casts Doubt on High-Tech Prostate Surgery

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"Patients are demanding it," agreed Dr. Stephen J. Freedland, associate professor of urology and pathology at Duke University Medical Center, who performs prostate surgery but does not do the minimally invasive version. "In many cases, if the surgeon is not offering it, the patient will not come to you. So you have no choice. You do robotic surgery, or you don't do surgery."

Men who have been diagnosed with prostate cancer usually go directly to the Internet for information, and what they usually find are reports about the benefits of minimally invasive robotic surgery, Freedland said.

"But we are learning more and more that there are not all the benefits that have been touted," he said. "There are some benefits. But for long-term outcomes, there is no benefit and perhaps some detriment."

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The numbers in the new study "are really worrisome," Freedland said. "They are finding an incontinence rate that is 30 percent higher and an erectile dysfunction rate that is 40 percent higher, and those are really important."

And the robotic technique is not readily mastered by surgeons, he said. "The learning curve is 150 to 200 patients, so the first 150 you do, you're practicing on them," Freedland said.

Men who are considering minimally invasive prostate surgery should first check carefully about the training of the surgeons doing the procedure, Hu said.

"They should go online to see how long the procedure has been available [at the clinic]," he said. "They should ask about how surgeons have been trained to do it, whether they have extensive training or just a standard three-day course."

Minimally invasive robotic surgery for prostate cancer is in an early stage of evolution, Hu said, and the surgical techniques needed to preserve urological function and prevent incontinence and impotence still have not been perfected.

More information

There's more on prostate cancer surgeries at the U.S. National Library of Medicine.

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