Highlights
- Robot-assisted radical prostatectomy (RARP) has shown to have better short-term outcomes for patients.
- However, studies are showing no difference between RARP and traditional surgery for longer-term cancer outcomes.
- Discuss any surgery carefully with your doctor before making a decision.
If you have prostate cancer, removing some or all of your prostate is a potential treatment option. In the short term, robot-assisted surgery is showing real promise in increasing surgical safety and reducing postsurgical complications, like erectile dysfunction (ED.) Yet it’s not clear that it matters in the longer term, and there are some real questions about the cost and benefits.
Why Would I Get a Radical Prostatectomy?
Generally speaking, radical prostatectomy, or removal of the entire prostate, is only considered in cases where you have prostate cancer that has a good chance of spreading to the rest of your body. While prostate surgery might be considered for other issues, such as mitigating benign prostatic hyperplasia (BPH), most radical prostatectomies are cancer related.
What Is RARP and How Is It Different From Traditional Surgery?
In a traditional radical prostatectomy, sometimes called an “open” prostatectomy, a doctor will open up the patient from their lower torso to their public bone before attempting to remove as much of the prostate as possible. In some cases, doctors will use “keyhole” surgery, going through the anus to remove the prostate instead.
As the name implies, a robot-assisted prostatectomy involves a surgeon using a set of robotic tools. Think of the surgeon as the pilot and the robot as the plane: The doctor makes the decisions and tells the robot where to go. The surgery usually involves only a few small incisions in the abdomen. The robotic tools are inserted through the incisions and guided by the surgeon, who sits at a computer console and is in control throughout the procedure.
Why Is Robot-Assisted Radical Prostatectomy (RARP) Popular?
A radical prostatectomy is a complicated procedure. The prostate is located deep in the body and is surrounded by nerves, blood vessels, and muscles you need. It’s also right next to the urethra, putting patients at risk for damage to their urinary system.
The value of robot-assisted procedures is that robotically guided tools are much more precise than a surgeon’s hands, so they can remove a prostate with as few cuts as possible, helping to reduce post-prostatectomy complications like erectile dysfunction.
Because the entire gland is removed, less cancerous tissue is left behind. Surgeons can sit during the procedure and have more flexibility and range of movement.
Robots don’t get tired or need a break, so the amount of time you’re in surgery is much less. Fewer errors and more precision means recovery from surgery is easier. Yet the jury seems to be out on whether it results in better outcomes.
RARP vs. Traditional Surgery: Which Is Better?
In the short term, RARP has become popular because it mitigates many of the risks associated with surgery. A Harvard study of over 1,000 men undergoing radical prostatectomy found that RARP patients had shorter recovery times, fewer complications, and lower postsurgical pain scores.
That said, it’s worth noting that postsurgical issues were less common overall. For example, the study found that a common problem, scar tissue in the urethra that blocked the flow of urine, called bladder neck contracture, turned up in 45 men out of 545 who underwent traditional surgery, while only nine men out of 549 who underwent robotic surgery had the same complication.
Still, many doctors will tell you that the principle of “do no harm” tilts them toward the robotic procedure. Even a small reduction in risk matters. Longer term, though, the robotic approach doesn’t appear to affect outcomes. Even advocates for robotic surgery are clear that cancer outcomes are the same whether you have an open prostatectomy or let a robot do it. Before we write off the robot, however, we should remember that some of this is due to the nature of prostate cancer itself.
Is RARP Worth the Cost?
The first objection to RARP is due to a reconsideration of prostatectomy as a treatment in the first place. While prostate cancer is the second most common cancer in men and the most common in men over 50, lung cancer causes nearly a quarter of all cancer deaths in men while only accounting for 12 percent of cancer diagnoses.
With prostate cancer, meanwhile, 98 percent of those diagnosed are still alive five years later. As men get older, their odds of prostate cancer increase, but heart disease is the cause of death for nearly a third of all men over 85, while only 15 percent die from cancer of any type. In fact, a study of older men after death found that many of them had prostate cancer that hadn’t even been diagnosed.
This has led to a reconsideration of prostate cancer focused on health and well-being. The thinking goes that if prostate cancer isn’t that dangerous, it’s better to monitor it and focus on other risks instead to keep patients healthier.
A second objection to RARP is the cost. One surgical robot, while capable of multiple procedures, costs $2 million, and that cost is passed onto the patient. If there’s no change in outcome, it raises the question of whether paying that much more makes sense.
This is the most difficult question because it hinges on medical ethics. As we noted, robotic surgery has undeniable short-term benefits for the patient, and those benefits become more important with older patients. Anything that reduces blood loss, recovery time, and postsurgical complications in any form is often viewed as worth the cost.
How Can I Decide If RARP Is Right for Me?
If you’re looking at prostatectomy, the best place to start is by asking your doctor if prostatectomy is the only option or if there are other treatments you can try first. Review the possible risks of prostatectomy procedures against simply monitoring it. Discuss the possible risks and postsurgical complications of each procedure, such as ED. And be clear on the possible results of both surgery and watchful waiting.
Regardless of your surgery method, post-prostatectomy ED is a possible complication, and ED medication is an effective tool for managing it. Thinking ahead and being informed is the best way to ensure a good recovery from prostatectomy and to manage post-surgical complications.
To learn more about ED treatment and for the latest news on ED during all stages of life, follow our blog. To browse our medication guide, visit our erectile dysfunction page.
Dan is a long-time freelance writer focusing on technology, science, health, and medicine, with a lifelong interest in physics, biology, and medicine. His work has taken a particular focus on scientific studies “beyond the headlines,” reading the study to more closely examine the results.