High-risk prostate cancer: too risky for the robotic learning curve
Article first published online: 23 JUL 2013
© 2013 BJU International
Volume 112, Issue 4, page E321, August 2013
How to Cite
Meeks, J. J. and Eastham, J. A. (2013), High-risk prostate cancer: too risky for the robotic learning curve. BJU International, 112: E321. doi: 10.1111/j.1464-410X.2012.11496.x
- Issue published online: 23 JUL 2013
- Article first published online: 23 JUL 2013
- Sidney Kimmel Center
Men with high-risk prostate cancer are at greater risk of metastasis and death from prostate cancer, emphasising the importance of sound oncological principles in their treatment. In a single institution non-randomised series of 410 patients, Punnen et al.  attempt to determine if robot-assisted radical prostatectomy (RARP) is as effective as open RP for treating men with high-risk prostate cancer. Men who underwent RARP had similar rates of positive surgical margins and biochemical recurrence at 2 and 4 years. Yet, those men treated early in their robotic learning curve (before 2006) were more likely to have a positive margin on multivariate analysis. Further evidence for the impact of the surgical learning curve was the low rate of lymphadenectomy in patients with high-risk prostate cancer that underwent RARP. A lymphadenectomy was not performed in 37% of men undergoing RARP and the mean lymph node count was 11 nodes compared with 15 obtained from open RP (P < 0.01). Not surprisingly, only 3% of in men that underwent RARP had positive lymph nodes compared with 14% found at open RP. While this study is underpowered to determine superiority of open RP compared with RARP, it does provide evidence that a surgeon early on their learning curve (whether open or robotic), should consider avoiding surgery on men with high-risk disease. The future of RP will probably involve less surgery for men with low-risk disease that can be watched, which will probably shift the role of surgical management to men with higher risk disease. Thus, whether the surgeon performs an operation with his hands or with robotic assistance, the importance of surgical technique and the quality of surgery remain paramount to men with high-risk disease.
Supported by the Sidney Kimmel Center for Prostate and Urologic Cancers.