Patient-reported outcomes after open RP, laparoscopic RP & permanent prostate brachytherapy.

[pjoshea13]

New study from Japan [1].

"Urinary function and bother were worst after laparoscopic radical prostatectomy, especially in the early postoperative phase, whereas urinary obstructive/irritative symptom, bowel function and bother were worse after permanent prostate brachytherapy."

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/314...

Jpn J Clin Oncol. 2019 Aug 22. pii: hyz116. doi: 10.1093/jjco/hyz116. [Epub ahead of print]

Patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy.

Hashine K1, Kakuda T1, Iuchi S1, Tomida R1, Matsumura M1.

Author information

1

Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.

Abstract

OBJECTIVE:

To assess patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy.

METHODS:

patient-reported outcomes were evaluated using Expanded Prostate Cancer Index Composite scores at baseline and 1, 3, 6, 12 and 36 months after treatment, respectively, using differences from baseline scores.

RESULTS:

Urinary function was the same in the three groups at baseline, but worse after surgery than after permanent prostate brachytherapy until 12 months, and similar after open radical prostatectomy and permanent prostate brachytherapy and better than after laparoscopic radical prostatectomy at 36 months. Urinary bother was significantly worse at 1 month after surgery, but better after open radical prostatectomy than after permanent prostate brachytherapy and laparoscopic radical prostatectomy at 3 months, after which symptoms improved gradually in all groups. Obstructive/irritative symptoms were worse after permanent prostate brachytherapy than after open radical prostatectomy at 36 months, and worse after laparoscopic radical prostatectomy until 6 months. Urinary incontinence was worse after surgery, particularly after 1 month. This symptom returned to the baseline level at 12 months after open radical prostatectomy, but recovery after laparoscopic radical prostatectomy was slower. Bowel function after permanent prostate brachytherapy was significantly worse than after surgery at 1 month and this continued until 6 months. Bowel bother was slightly worse at 3 and 6 months after permanent prostate brachytherapy compared to these time points after surgery.

CONCLUSION:

Urinary function and bother were worst after laparoscopic radical prostatectomy, especially in the early postoperative phase, whereas urinary obstructive/irritative symptom, bowel function and bother were worse after permanent prostate brachytherapy. These findings are useful and informative for the treatment of patients with prostate cancer.

© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: [e-mail].

KEYWORDS:

Expanded Prostate Cancer Index Composite; laparoscopic radical prostatectomy; open radical prostatectomy; patient-reported outcome; permanent prostate brachytherapy

PMID: 31436793 DOI: 10.1093/jjco/hyz116

[snoraste]

.. the debate continues ...

[AlanMeyer]

I expect to see different side effects from surgery vs. radiation, but I wouldn't expect worse side effects from laparoscopic surgery than open surgery. In theory, the two treatments are the same except that with open surgery, more of the patient gets sliced open. My impression is that all of the top surgeons in the U.S. are doing laparoscopic.

I'm also surprised by the statement that all of the open surgery patients returned to baseline urinary continence by 12 months. Really? My suspicion is that the notion of "baseline" only means that they don't routinely wet their pants or their beds, but I bet a lot of them still drip when they sneeze, cough, jump, or run, and never did that at "baseline".

I have read theories in the past that say that laparoscopic surgery requires more training and experience than open surgery, which makes me wonder if this was a factor in the Japanese study. If so, then patients should be extra careful to about finding an experienced specialist to do the procedure. But I seriously question the idea that they should choose open surgery in preference to laparoscopic.

Alan

[cesanon in reply to AlanMeyer]

"laparoscopic surgery requires more training and experience than open surgery,"

They take longer as well. Length of surgery has been traditionally associated with lower quality results.... by a lot.

[Hidden]

I would like to see more studies that cover the survival outcomes after 5 years. All the numbers I have seen so far seem to indicate there is little difference - so all that pain, expense, incontinence, has a zero gain. We see two things in this forum - many get the "cut and burn" treatment up front, while many others (were they lucky to be "too far gone to be operable"?) seem to have no visible cancer in their prostates after a couple years - their body did the fix job. I have seen zero cases where there were later problems because the prostate was not removed, so if there are members of this forum where this was the case, please speak up so we can correct that zero.

[Lyubov in reply to Hidden]

Am I understanding your analysis correctly. Namely, that radical prostatectomy should never be performed for diagnosed PCa?

[pjoshea13 in reply to Lyubov]

There is an old study that showed that the 'curative' treatment one receives for PCa depends on whether one first sees an oncologist or a urologist. In the U.S., I think it is a disgrace that the AMA fails to protect newly diagnosed men from such bias.

In the end, the decision is supposedly made by the patient (as though the patient is qualified to make that decision). Men tend to feel that they made the right choice, even if the outcome wasn't good. & so, the bias is perpetuated.

I have read one oncologist who has said that urologists are motivated by greed & that it is a historical accident that they do PCa surgery. As though barbers were still practicing dentistry. It is disturbing to read such stuff.

-Patrick

[Lyubov in reply to pjoshea13]

In my husband's case neither urologists nor radiologists nor our family physician of 15 years pushed for surgery. We researched a great deal -- there was time for that -- talked to other men who had various treatments & made our decision.

[kapakahi in reply to pjoshea13]

My own urologist said the same thing about his own profession: the reason there are so many RPs is down to urologist greed. That was sobering. It stands to reason (well, my reason, which may not be all that reasonable) that surgery cannot help but allow the release of some cancer cells just through simple bleeding - exacerbated perhaps by the narrow confines and small size of the prostate.

[monte1111 in reply to pjoshea13]

Very scary reading. I think I would have gone with a RP that Uro would no doubt have encouraged. Bailed out and went with another insurance plan. A RP would have done nothing because of my wide spread mets. I have for years thought that bonuses, in medical or any other field leads to the corruption that is so rampant everywhere.

[Hidden in reply to Lyubov]

I think the problem comes from an antiquated "Cancer Manual" which pushes for radical early procedures - the "Get it all!" thinking. But that is now known to be impossible for other cancers as well. Long before (years) one gets a "You have Prostate Cancer!", the blood is carrying lots of stray cancer cells throughout the body, and these in turn start mets all over the place - but they are tiny and most will never become a detectable tumor. There are companies that will isolate these cancer cells from your blood and check what goes on, which makes a dangerous biopsy largely redundant too. They would not be in business if there were not plenty of stray cancer cells floating about in a normal blood sample. For a bit extra they will culture these cells and test various treatments for effect.

These new findings also make "stages" moot. Are we at Stage IV before we even know we have any problem at all? The poor results from the "Get it all - cut and burn!" policy would suggest this is the case.

This all started with a simple layman's observation - leaving the prostate in place does not seem to make a Prostate cancer victim any worse off (and not wearing nappies is a big plus). We will see if any forum members regret not having it out - if this is such a "vital" treatment, we should get hundreds say (in retrospect) they should have had it done.

[tallguy2]

Thank you for posting this. I think a bigger issue is that physicians now know that cells can be left behind with the "DaVinci" RP procedure.

[Lyubov in reply to tallguy2]

Is there any procedure / treatment that won't leave cells "behind"? Plus, what's to be done about the micro cells that have already "gotten away." A lot more research needed. . .

[tallguy2 in reply to Lyubov]

Agreed.

[timotur]

This and other forums helped me make a more informed decision and get a more balanced view. Ar the beginning, the hardest part was figuring out which doc to start with. After a high risk 4K score, I chose Dr Bahn for a biopsy, who seemed impartial and had a lot of experience. That was half the battle. For stage 3b + SV, I chose HDR-BT, and not sure I would have if I started with a local Uro.