Comparing surgery and radiation for prostate cancer
The following table compares outcomes following prostate cancer treatment -- specifically, surgery (radical prostatectomy), which is considered the gold standard treatment for localized prostate cancer -- and radiation (brachytherapy and external beam radiation). Data is provided on survival, cancer recurrence, incidence of rectal and bladder cancer, bowel function, urinary bother and long-term erectile function. In this table, radical prostatectomy includes all approaches to prostate surgery (open surgery through large incisions; conventional minimally invasive, or laparoscopic radical prostatectomy -- also called LRP -- as well as da Vinci® prostatectomy, or dVP). As you can see, surgery offers measurable advantages over radiation in terms of outcomes and survivability.
| Chart 1: Outcome Comparison: Surgery vs. Radiotherapy | ||
| Outcome | Radical Prostatectomy* | Radiation** |
| Survival duration compared to conservative disease management1 | 8.6 years | 4.6 years |
| 15-year prostate cancer survival rate2 | 92% | 87% |
| Survival rate for high-grade cancer patients3 | 45% increase in overall survival rate vs. radiotherapy | - |
| Risk of cancer-specific death for high-grade cancer patients4 | 49% less risk vs. radiotherapy | - |
| Cancer recurrence5 | Easy to detect | Difficult to detect |
| Risk of rectal cancer (Within 10 year follow-up)6 | 5.1 out of 1000 | 10.0 out of 1000 |
| Risk of bladder cancer7 | 0.8% developed bladder cancer | 1.3% developed bladder cancer |
| Bowel function impairment8 | - | Significantly greater vs. surgery |
| Disease-specific long-term quality of life9 | Stable | Unstable |
| Painful urination (at 18 month follow-up)10 | 1% of patients | 30% of patients |
| Long-term erectile dysfunction11 | Lower risk | Higher risk |
| *Open surgery; comparable long-term data not yet available on da Vinci® Prostatectomy. | ||
| **External Beam Radiation Therapy (EBRT) unless otherwise noted in the citation. |
Comparing open vs. laparoscopic vs. da Vinci Surgery for prostate cancer
The following table looks at patient outcomes following surgery for prostate cancer (radical prostatectomy), and compares "best in class" data from three types of surgery. As you can see, da Vinci® prostatectomy (dVP) shows measurable advantages as compared to both conventional open surgery (open), performed through large incisions, as well as conventional minimally invasive laparoscopic (lap) surgery.
| Chart 2: da Vinci® vs. Open vs. Conventional Laparoscopy | |||
| Outcome | da Vinci© | Open | Lap |
| Cancer control | |||
| T2 margin status | 4.51 | 5.92 | 7.73 |
| Complications | |||
| Estimated blood loss (EBL) | 109 ml4 | 1355 ml5 | 380 ml6 |
| Length of stay (LOS) | 1.2 days4 | 3 days5 | 2.5 days13 |
| Major | 1.7%4 | 6.7%5 | 3.7%6 |
| Minor | 3.7%4 | 12.6%5 | 14.6%6 |
| Urinary function | |||
| 3 month | 92.9%7 | 54%8 | 62%9 |
| 6 month | 94.9%7 | 80%8 | 77%9 |
| 12 month | 97.4%7 | 93%8 | 83%9 |
| Sexual function | |||
| 12 month | 86%11 | 71%11 | 76%12 |
References for chart 1:
[1] Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74.
[2] Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74.
[3] Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus D, Menon M. Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy--a propensity scoring approach. J Urol. 2007 Mar;177(3):911-5. Erratum in: J Urol. 2007 May;177(5):1958.
[4] Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus D, Menon M. Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy--a propensity scoring approach. J Urol. 2007 Mar;177(3):911-5. Erratum in: J Urol. 2007 May;177(5):1958.
[5] Di Blasio, C. J., A. C. Rhee, et al. (2003). Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol 30(5): 567-86.
[6] Baxter NN, Tepper JE, Durham SB, Rothenberger DA, Virnig BA. Increased risk of rectal cancer after prostate radiation: a population-based study. Gastroenterology. 2005 Apr;128(4):819-24.
[7] Boorjian S, Cowan JE, Konety BR, DuChane J, Tewari A, Carroll PR, Kane CJ; Cancer of the Prostate Strategic Urologic Research Endeavor Investigators. Bladder cancer incidence and risk factors in men with prostate cancer: results from Cancer of the Prostate Strategic Urologic Research Endeavor. J Urol. 2007 Mar;177(3):883-7; discussion 887-8.
[8] Litwin MS, Sadetsky N, Pasta DJ, Lubeck DP. Bowel function and bother after treatment for early stage prostate cancer: a longitudinal quality of life analysis from CaPSURE. J Urol. 2004 Aug;172(2):515-9.
[9] Miller, D. C., M. G. Sanda, et al. (2005). Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy. J Clin Oncol 23(12): 2772-80.
[10] Buron, C., B. Le Vu, et al. (2007). Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 67(3): 812-22.
[11] Di Blasio, C. J., A. C. Rhee, et al. (2003). Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol 30(5): 567-86.
References for chart 2:
[1] Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology. 2004 May;63(5):819-22. p. 821 table III.
[2] Scardino PT. Open Radical Retropubic Prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, California, Sept. 30 – Oct. 1 2005
[3] Touijer K, Kuroiwa K, Saranchuk JW, Hassen WA, Trabulsi EJ, Reuter VE, Guillonneau B. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical margin. J Urol. 2005 Mar;173(3):765-8. p. 766 (Results)
[4] Bhandari, A., McIntire, L., Kaul, S.A., Hemal, A.K., Peabody, J.O., and Menon, M. (2005). Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 174, 915-918.
[5] Brown, J.A., Garlitz, C., Gomella, L.G., McGinnis, D.E., Diamond, S.M., and Strup, S.E. (2004). Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urologic oncology 22, 102-106.
[6] Guillonneau, B., Rozet, F., Cathelineau, X., Lay, F., Barret, E., Doublet, J.D., Baumert, H., and Vallancien, G. (2002). Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. The Journal of urology 167, 51-56.
[7] Locke, DR, Klimberg IW and Sessions RP. Robotic Radical Prostatectomy With Continence And Potency Sparing Technique: An Analysis Of The First 250 Cases. Submitted To Journal Of Urology, Publication Date TBD. p. 5 table 4.
[8] Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul;164(1):242. p. 59 table 1.
[9] Goeman, L., Salomon, L., La De Taille, A., Vordos, D., Hoznek, A., Yiou, R., and Abbou, C.C. (2006). Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol 24, 281-288.
[10] Kaul, S., Bhandari, A., Hemal, A., Savera, A., Shrivastava, A., and Menon, M. (2005). Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology 66, 1261-1265.
[11] Parsons JK, Marschke P, Maples P, Walsh PC. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology. 2004 Nov;64(5):987-90.
[12] Su, L.M., Link, R.E., Bhayani, S.B., Sullivan, W., and Pavlovich, C.P. (2004). Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology 64, 123
[13] Dahl DM, L'esperance JO, Trainer AF, Jiang Z, Gallagher K, Litwin DE, Blute RD Jr. “Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center.”Urology. 2002 Nov;60(5):859-63.