Prostatectomy Treatment Comparison
Open Surgery vs. Radiation Therapy
While long-term data is not yet available comparing da Vinci® Surgery to radiation, there are large studies comparing open surgery with radiation. This evidence suggests that removing the prostate (radical prostatectomy) offers patients a better chance of survival compared to radiation.
The following table compares patient outcomes following open surgery for prostate cancer - considered the gold standard treatment for localized cancer - and radiation or radiotherapy (brachytherapy and external beam radiation). Data is provided on survival, cancer recurrence, incidence of rectal and bladder cancer, bowel function, urinary issues and long-term erectile function.
In the table below, radical prostatectomy includes all approaches to prostate surgery: open surgery through large incisions, manual laparoscopic prostatectomy, as well as da Vinci robotic-assisted prostatectomy. As shown in the table, all types of surgery offer measurable advantages over radiation in terms of outcomes and survival rates.
Outcome Comparison: Surgery vs. Radiation
|Survival duration compared to conservative disease management1
|15-year prostate cancer survival rate1
|Survival rate for high-grade cancer patients2
||44% increase in overall survival rate vs. radiotherapy
|Risk of cancer-specific death for high-grade cancer patients2
||49% less risk vs. radiotherapy
|Bowel function impairment3
||Significantly greater versus surgery
|Disease-specific long-term quality of life4
|Painful urination (at 24 month follow-up)5
||2.1% of patients
||19% of patients
*External Beam Radiation Therapy (EBRT) unless otherwise noted in the citation.
Long-Term Survival for Localized Prostate Cancer
With any cancer treatment, the first priority is survival. A recent study suggests there is a greater chance of long-term survival for patients undergoing surgery when compared to other treatments.6
In this large study of patients receiving treatment for prostate cancer, those receiving radiation (including IMRT) and hormone therapy were two and three times more likely to die, respectively, than radical prostatectomy (surgery) patients.6 In fact, surgery patients who had their cancerous prostate removed had the lowest cancer death rate.6
In a previous study that included watchful waiting, the patients who had a radical prostatectomy had a higher prostate cancer survival rate than men choosing other treatments.7
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 features a magnified 3D high-definition vision system and special wristed instruments that bend and rotate far greater than the human wrist. As a result, da Vinci enables your doctor to operate with enhanced vision, precision, dexterity and control.
State-of-the-art da Vinci uses the latest in surgical and robotics technologies and is beneficial for performing complex surgery. Your surgeon is 100% in control of the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. da Vinci – taking surgery beyond the limits of the human hand.
Physicians have used the da Vinci System successfully worldwide in approximately 1.5 million various surgical procedures to date. da Vinci is changing the experience of surgery for people around the world.
Risks & Considerations Related to Prostatectomy & da Vinci Surgery
Potential risks of any prostatectomy procedure may include: any prostatectomy procedure include: urinary and sexual dysfunction due to nerve damage, rectal or bowel injury, blocked artery in the lung, blocked bowel, and surrounding nerve damage. In addition, there are special considerations related to minimally invasive surgery, such as complications from increased optic pressure for patients previously diagnosed with glaucoma (due to patient positioning during surgery) and hernia (bulging tissue) at incision site, although very uncommon).8,9
da Vinci Treatment Options for Prostate Cancer
- Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74
- Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus D, Menon M. Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy--a propensity scoring approach. J Urol. 2007 Mar;177(3):911-5. Erratum in: J Urol. 2007 May;177(5):1958
- Litwin MS, Sadetsky N, Pasta DJ, Lubeck DP. Bowel function and bother after treatment for early stage prostate cancer: a longitudinal quality of life analysis from CaPSURE. J Urol. 2004 Aug;172(2):515-9.
- Miller DC, Sanda MG, Dunn RL, Montie JE, Pimentel H, Sandler HM, McLaughlin WP, Wei JT. Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy.J Clin Oncol. 2005 Apr 20;23(12):2772-80.
- Buron C, Le Vu B, Cosset JM, Pommier P, Peiffert D, Delannes M, Flam T, Guerif S, Salem N, Chauveinc L, Livartowski A. Brachytherapy versus prostatectomy in localized prostate cancer: results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys.2007 Mar 1;67(3):812-22.
- Cooperberg MR, Vickers AJ, Broering JM, Carroll PR. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Nov 15;116(22):5226-34. doi: 10.1002/cncr.25456
- Merglen A, Schmidlin F, Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, Miralbell R, Bouchardy C. Short- and long-term mortality with localized prostate cancer. Arch Intern Med. 2007 Oct 8;167(18):1944-50.
- Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J, Jeldres C, Rogers CG, Peabody JO, Montorsi F, Menon M, Karakiewicz PI. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy: results from the nationwide inpatient sample. Eur Urol. 2012 Apr;61(4):679-85. Epub 2011 Dec 22.
- Tewari A, Sooriakumaran P, Bloch DA, Seshadri-Kreaden U, Hebert AE, Wiklund P. Positive Surgical Margin and Perioperative Complication Rates of Primary Surgical Treatments for Prostate Cancer: A Systematic Review and Meta-Analysis Comparing Retropubic, Laparoscopic, and Robotic Prostatectomy. Eur Urol. 2012 Feb 24.
All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php.
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PN 1002157 Rev A 04/2013 U 07/06/2012