Contradictory Findings and Using Caution When Researching Prostate Cancer Treatment Options

I like when the medical community shares the positive findings of new studies on robotic radical prostatectomy procedures. I like knowing that prostate cancer patients, mine and those just beginning to explore treatment options, can read about the many current successes of robotic prostate surgery. I like when the medical community is united in helping prostate cancer patients gain access to the best treatments available.

But what I find most difficult for those exploring prostate cancer treatment options is the widely varying reports often published. Facing a prostate cancer diagnosis is extremely difficult and research is a must. I urge all prostate cancer patients to spend time with their physicians discussing all options, and to gather as much information from as many sources as possible. But what you read and learn must be as carefully considered as the treatment decision itself. The volume of data can be overwhelming and making sense of wildly differing results can be daunting.

For example, prostate cancer surgeons at Weill Cornell Medical College in New York recently studied the outcomes of 110,016 prostatectomy patients, finding significant surgical benefits in those who underwent laparoscopic or robotic procedures. Representing roughly 40% of the pool, these patients experienced less blood loss and shorter hospital stays, and an overall lower perioperative morbidity rate. I know from my own practice that a robotic-assisted prostatectomy has significant surgical advantages. Not only is vision enhanced by 10x, it is also 3D. And the dexterity of the robot in my hands is unmatched. Incisions are small, the surgical field is not obstructed by excessive blood loss, movements are precise and recovery is much faster.

Even more encouraging about this study is the fact that a subgroup analysis showed that surgeons who performed 1,000 or more procedures had the most successful outcomes. With regard to robotic surgery, this is particularly true as a solid foundation in both open, traditional prostatectomy and laparoscopic prostatectomy are critical. The robot provides great advantages, but it cannot think and perform a procedure independent of a surgeon. Without the addition of the surgeon’s knowledge and, most importantly, experience, the robot does not know what to do. Great technology cannot replace medical expertise.

So, while it’s no surprise that the study validated the success of robotic prostatectomy procedures, I am surprised by what the survey leaders concluded next – and this is the part where the findings become confusing. The report goes on to speculate that a surgeon can become proficient in robotic surgery in as few as 50 procedures verses the hundreds of procedures needed to be successful in open or laparoscopic surgery. Are they suggesting that robotic surgery is a better option because it’s easier for the surgeon to learn? Perhaps it’s a misuse of the word “proficient”? Even still, if the study indicated higher success rates in surgeons with more experience, close to a thousand patients’ worth of experience, why would 50 create proficiency? And what is a patient left to think, that any surgeon who’s had his hands on the robot for a few months can figure out what to do?

The point to be made here is that even great studies with great results can provide contradictory information. Sometimes it’s because further research is needed. Sometimes it’s due to research variables or narrow study parameters. And sometimes it’s due to the goals of the researchers. Further, what you read in an article or a study summary is not the full story. Talk to your surgeon, talk to multiple surgeons, and be sure the information that’s guiding your treatment decision is accurate and comprehensive.

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