Robotic RP shows good cancer control, positive functional outcomes

An analysis of experience with nerve-sparing robot-assisted radical prostatectomy in more than 2,600 men after up to 5.5 years of follow-up indicates that the procedure provides good cancer control and functional outcomes comparable to those achieved with open surgery, urologists from the Vattikuti Urology Institute, Henry Ford Health System, Detroit, reported at yesterday's AUA annual meeting.

Robot-assisted prostatectomy was introduced for routine surgical care of men with localized prostate cancer in 2001. Men are generally considered for the procedure if they have nonfocal Gleason 6-9 cancer. Men with more than 25% Gleason 7 disease undergo conventional nerve sparing on the ipsilateral side. Otherwise, a veil nerve-sparing procedure is performed with preservation of the lateral prostatic fascia.

Between March 2001 and September 2006, 2,652 men underwent the Vattikuti Institute Prostatectomy (VIP). Complete follow-up data were available for 1,142 patients seen between 12 and 66 months postoperatively (median, 36 months).

Among men who underwent VIP using the most recent technique, the apical positive margin rate was only 1.5%. For the entire group, the actual biochemical recurrence rate was 2.3%, and the actuarial 5-year biochemical recurrence rate was 8.4%. Only 0.8% of men had total incontinence at 12 months, 84% had total control, and another 8% used a liner for security because of occasional stress incontinence. Among men without erectile dysfunction preoperatively, 93% were able to resume intercourse at 12 months after the procedure, although only about 50% had returned to baseline function.

"While our VIP technique continues to evolve, our experience in this very large group of men with long and robust follow-up indicates robot-assisted prostatectomy should no longer be designated as experimental. Furthermore, it should alleviate concerns that use of a somewhat aggressive nerve-sparing approach compromises our ability to achieve cancer control," said Mani Menon, MD, of the Vattikuti Urology Institute.