The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples

Brock O’Neil; Tatsuki Koyama; JoAnn Alvarez; Ralph M Conwill; Peter C Albertsen; Matthew R Cooperberg; Michael Goodman; Sheldon Greenfield; Ann S Hamilton; Karen E Hoffman; Richard M Hoffman; Sherrie H Kaplan; Janet L Stanford; Antoinette M Stroup; Lisa E Paddock; Xiao-Cheng Wu; Robert A Stephenson; Matthew J Resnick; Daniel A Barocas; David F Penson

doi:10.1016/j.juro.2015.08.092

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The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples

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The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples

Brock O’Neil, Tatsuki Koyama, JoAnn Alvarez, Ralph M Conwill, Peter C Albertsen, Matthew R Cooperberg, Michael Goodman, Sheldon Greenfield, Ann S Hamilton, Karen E Hoffman, …

The Journal of urology, Vol.195(2), pp.321-329

02/2016

DOI: 10.1016/j.juro.2015.08.092

PMCID: PMC4916911

PMID: 26343985

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Abstract

Robotic assisted radical prostatectomy has largely replaced open radical prostatectomy for the surgical management of prostate cancer despite conflicting evidence of superiority with respect to disease control or functional sequelae. Using population cohort data, in this study we examined sexual and urinary function in men undergoing open radical prostatectomy vs those undergoing robotic assisted radical prostatectomy. Subjects surgically treated for prostate cancer were selected from 2 large population based prospective cohort studies, the Prostate Cancer Outcomes Study (enrolled 1994 to 1995) and the Comparative Effectiveness Analysis of Surgery and Radiation (enrolled 2011 to 2012). Subjects completed baseline, 6-month and 12-month standardized patient reported outcome measures. Main outcomes were between-group differences in functional outcome scores at 6 and 12 months using linear regression, and adjusting for baseline function, sociodemographic and clinical characteristics. Sensitivity analyses were used to evaluate outcomes between patients undergoing open radical prostatectomy and robotic assisted radical prostatectomy within and across CEASAR and PCOS. The combined cohort consisted of 2,438 men, 1,505 of whom underwent open radical prostatectomy and 933 of whom underwent robotic assisted radical prostatectomy. Men treated with robotic assisted radical prostatectomy reported better urinary function at 6 months (mean difference 3.77 points, 95% CI 1.09–6.44) but not at 12 months (1.19, −1.32–3.71). Subjects treated with robotic assisted radical prostatectomy also reported superior sexual function at 6 months (8.31, 6.02–10.56) and at 12 months (7.64, 5.25–10.03). Sensitivity analyses largely supported the sexual function findings with inconsistent support for urinary function results. This population based study reveals that men undergoing robotic assisted radical prostatectomy likely experience less decline in early urinary continence and sexual function than those undergoing open radical prostatectomy. The clinical meaning of these differences is uncertain and longer followup will be required to establish whether these benefits are durable.

robotics

prostatectomy

patient outcome assessment

Details

Title: Subtitle: The Comparative Harms of Open and Robotic Prostatectomy in Population Based Samples
Creators: Brock O’Neil - Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
Tatsuki Koyama - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
JoAnn Alvarez - Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
Ralph M Conwill - CEASAR Patient Advocacy Network
Peter C Albertsen - Division of Urology, University of Connecticut Health Center, Farmington, Connecticut
Matthew R Cooperberg - Department of Urology, University of California San Francisco, San Francisco
Michael Goodman - Department of Epidemiology, Emory University, Atlanta, Georgia
Sheldon Greenfield - Department of Medicine, University of California, Irvine, Irvine
Ann S Hamilton - Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
Karen E Hoffman - Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
Richard M Hoffman - Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
Sherrie H Kaplan - Department of Medicine, University of California, Irvine, Irvine
Janet L Stanford - Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
Antoinette M Stroup - New Jersey State Cancer Registry, Trenton, New Jersey
Lisa E Paddock - New Jersey State Cancer Registry, Trenton, New Jersey
Xiao-Cheng Wu - Louisiana State University Health Sciences Center, New Orleans, Louisiana
Robert A Stephenson - Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
Matthew J Resnick - Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
Daniel A Barocas - Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
David F Penson - Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee
Resource Type: Journal article
Publication Details: The Journal of urology, Vol.195(2), pp.321-329
DOI: 10.1016/j.juro.2015.08.092
PMID: 26343985
PMCID: PMC4916911
NLM abbreviation: J Urol
ISSN: 0022-5347
eISSN: 1527-3792
Publisher: Elsevier Inc
Language: English
Date published: 02/2016
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094401702771

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