Prostate-surgery option questioned

More men who need prostate-cancer surgery are choosing minimally invasive techniques because these surgeries typically lead to shorter hospital stays and decrease many types of complications, including pain. This type of surgery, which often includes the use of a robot, is heavily advertised to consumers.

Minimally invasive techniques increased from 1 percent to 40 percent of all radical prostatectomies from 2001 to 2006 and may be as high as 75 percent of all prostate-cancer surgeries today.

But here's a detail men should know about: The most serious complications — including incontinence and erectile dysfunction — appeared more often in men who underwent minimally invasive surgery compared to traditional surgery, according to a study published Tuesday in the Journal of the American Medical Association.

Researchers compared the outcomes for men with prostate cancer who underwent a minimally invasive procedure to men who had traditional radical prostatectomy surgery. The men who had minimally invasive surgery had shorter hospital stays (two days compared to three days), were less likely to receive transfusions (2.7 percent compared to 20.8 percent) and were at lower risk of respiratory complications (4.3 percent compared to 6.6 percent).

However, they experienced more urinary- and genital-function complications; 4.7 percent compared to 2.1 percent.

Although minimally invasive robotic surgery may eventually offer advantages over traditional surgery for all men, there is a learning curve among surgeons using the technology, said Dr. Jim Hu, the lead author of the paper, from Brigham and Women's Hospital in Boston.

"There has been rapid adoption of minimally invasive radical prostatectomy, however outcomes have not been superior," Hu said, adding that the option appeared to have been oversold.

"I think that is certainly the story I would tell based on our findings," Hu said. "In our health-care system, perhaps a lot of community hospitals felt the need to be competitive ... and they acquired these robots and marketed them before there has been diffusion of experience among surgeons."

Studies should be performed to determine the rate of complications as more surgeons develop expertise with the technology, he said.

In the meantime, it might behoove men who choose this option to ask about the surgeon's experience.