Robotic Prostatectomy is Popular, but Not Superior to Other Options, Study Says

While current clinical data support no difference in the survival outcomes of prostate cancer patients after robotic surgery or radiation therapy, men tend to prefer surgery after consulting with their urologists and radiation oncologists, according to a small Australian study.

Researchers found that treatment choices were primarily influenced by recommendations from clinicians, mainly urologists, and think that incomplete or biased information is often conveyed to patients.

The study, “Robot or radiation? A qualitative study of the decision support needs of men with localized prostate cancer choosing between robotic prostatectomy and radiotherapy treatment,” was published in the journal Patient Education and Counseling.

When a man receives a diagnosis of localized prostate cancer, the most common treatments offered are radical prostatectomy — surgical removal of the prostate and surrounding tissues — radiation therapy, or active surveillance.

While the survival outcomes of these approaches are similar, each is linked with different effects on quality of life. “Radiotherapy is more likely to cause bowel dysfunction, while urinary incontinence and erectile dysfunction are more common after radical prostatectomy,” researchers said.

Robotic-assisted radical prostatectomy is becoming popular because it minimizes side effects; nonetheless, there is limited evidence of better results with this approach.

“There is ongoing debate over the best way to manage men with localized prostate cancer,” Ben Smith, co-deputy director of the University of New South Wales Centre for Oncology Education and Research Translation at the Ingham Institute, Australia, and the study’s first author, said in a press release.

“Robotic prostatectomy is fast becoming the treatment of choice for many men, despite potentially high costs, and limited evidence supporting its superiority over other treatments,” he said.

In this study, researchers examined the preferences of men with localized prostate cancer, before and after consulting with urologists and radiation oncologists.

“This is the first piece of research that specifically explores decision making in Australian men with localized prostate cancer considering robotic prostatectomy,” Smith said.

The study included 25 patients who completed a set of 39 interviews — 15 conducted before and 24 after clinical consultation with a radiation oncologist and a urologist.

Before clinical consultation, 13 participants were inclined to undergo robotic-assisted radical prostatectomy, while two patients wanted radiotherapy. All the patients went on to receive the initially chosen treatment, except for one patient who had first chosen robotic surgery and later opted for radiation therapy.

Ten patients were undecided before the consultation. After the consultation, six opted for robotic surgery and four received radiation therapy.

After analyzing the interviews, researchers found that patients’ decisions were mainly based on their trust in clinicians and the information they provided. Because clinicians constitute a primary source of information and have extensive qualifications and expertise, patients considered the information they provided as reliable.

“We found that men made decisions largely based on clinicians’ recommendations — they trusted in clinicians and the information they provide to men is of course critical for treatment choice,” Smith said.

The study participants believed that robotic prostatectomy provided a more definite cure for prostate cancer than radiation, suggesting that their decision originated from incomplete or biased information.

The fit between treatment characteristics and personal circumstances and conditions such as specific side effects, socio-emotional and financial factors were also taken into account by the participants. Specific side effects such as incontinence and impotence were a concern for most patients, but did not play a key role in treatment choice for most.

Researchers found that patients who chose robotic surgery felt they were able to endure and recover from the procedure because they were younger or had a better health status, whereas men who opted for radiotherapy were older or less healthy.

Although clinicians were the preferred source for information, participants also highlighted the need for balanced and tailored information delivery.

“Our study shows that men with localized prostate cancer need more balanced and complete information about robotic prostatectomy and radiotherapy, and they need it earlier in the process — so that they can participate in shared decision making, as recommended by guidelines,” Smith said.

Researchers advocate for a joint consultation with a urologist and a radiation oncologist shortly after diagnosis.

“We are also trialing a Question Prompt List outlining possible questions about all available treatment options as a way of satisfying men’s desire to get information directly from trusted clinicians, while accommodating varied preferences regarding information content and detail,” Smith said.

They highlighted, however, that this is a small study with a small number of patients and is not representative of the large prostate cancer population.

“We only included men with localized prostate cancer wanting the option of having robotic prostatectomy as curative treatment via the public health system. The perspectives of men who preferred other treatment approaches, or decided to pay for a robotic prostatectomy in the private system, are not represented,” Smith said.