Surprisingly, use of MIRP, still a new procedure, nearly tripled during the time this study was conducted, from 12.2 percent of procedures in 2003 to 31.4 percent in 2005. This happened despite scant evidence on how MIRP compared with more traditional surgery, the investigators stated.
The reason for this quick adoption, said study author Dr. Jim Hu, director of minimally invasive urologic oncology at Brigham and Women's Hospital/Dana-Farber Cancer Institute in Boston, is heavy direct-to-consumer advertising. "A lot of people are jumping the gun before any studies are out," he said. "And the studies that are out are from high-volume, single-center hospitals or academic institutions rather than what's going on nationwide."
This study involved 2,702 men undergoing one or the other procedure between 2003 and 2005, all of them Medicare beneficiaries.
MIRP was associated with fewer perioperative complications than open radical prostatectomy (29.8 percent versus 36.4 percent, respectively) and shorter hospital stays (1.4 versus 4.4 days).
This was noteworthy, the authors stated, because a greater proportion of older men and those with other health problems chose minimally invasive surgery over open radical prostatectomy. These men would automatically be at higher risk for complications.
But, 27.8 percent of men undergoing MIRP needed salvage therapy (hormone therapy or external-beam radiotherapy) within six months of the surgery, compared with only 9.1 percent of those undergoing the more traditional surgery.
And this procedure was associated with a higher risk of scar tissue, which can lead to incontinence and the need for further surgery.
The study did not look at staging and scoring of the tumor, meaning that some of the differences seen might be due to differences in disease rather than in surgical quality, Sawczuk said.
On the other hand, outcomes between the two procedures were more equal when MIRP was performed by surgeons with greater experience. But studies have shown that surgeons may need to perform as many as 150 procedures to duplicate the results of open surgery and as many as 300 to feel comfortable, Hu said.
"This is relatively new, and patients are all excited about it and, as a result of increased demand, the suppliers or surgeons want to rush and give patients what they want, but this is definitely something where a lot of practice is needed," Hu said.
More information
Visit the National Cancer Institute for more on treatment for prostate cancer.
