Similar Outcomes for New and Old Prostate Surgeries
Side effects and results similar in both types of surgery, study says 

By Will Boggs, MD

Wednesday, Sept. 9 (Reuters Health) -- If you've decided that a surgeon should remove your prostate and you're trying to figure out which kind of surgery is best, a new study may assure you that traditional techniques perform just as well as newer techniques.

Men who are diagnosed with prostate cancer often decide to have their prostate glands removed. In the traditional version of such surgery, sometimes referred to as "open," doctors make a cut just below the belly button, large enough to remove the walnut-sized gland.

In the newer form of the procedure, laparoscopy, a surgeon makes several smaller cuts through which he inserts a small camera and other tools to do the operation. Surgeons often tell patients that they can return to regular activities more quickly after such operations.

However, based on the results of the study, "Both approaches for most patients are equivalent, and it is best to go with the approach with which the patient's surgeon feels most comfortable," Dr. W. Scott McDougal from Massachusetts General Hospital and Harvard Medical School told Reuters Health in an email. "That having been said, I think the laparoscopic approach will replace the open approach over the next several years."

Dr. McDougal and colleagues compared outcomes in 102 patients who had radical prostatectomy using a traditional approach and 104 who had laparoscopic surgery. Their results appear in The Journal of Urology.

There were no differences between the groups in urinary incontinence, or ability to sustain an erection without medication - both of which are frequent side effects of radical prostatectomy. Neither did the groups differ in the success of surgeons in removing the entire tumor.

The risk of complications, albeit modest in both groups, was significantly greater with laparoscopy, with a slightly higher rate of blood in the urine and swelling.

Still, some patients may benefit from a particular approach. "I think the laparoscopic approach has clear advantages for the markedly obese patient," Dr. McDougal said. "Occasionally, some patients who have had previous pelvic surgery or injuries to the pelvis are better approached open."

"This study confirms that for radical prostatectomy the surgical approach does not determine patient outcomes, but it is rather surgeon experience and judgment," writes Dr. Jeffrey A. Cadeddu from University of Texas Southwestern Medical Center, Dallas, Texas in a related editorial.

SOURCE: Journal of Urology, September 2009

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