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Queensland researchers have conducted a world-first trial comparing the merits of robotic-assisted prostatectomy to open prostatectomy, finding that both approaches provide equal outcomes for urinary and erectile function. Advanced robotic technology was also found to offer a safer and minimally invasive option for men diagnosed with prostate cancer, the researchers said.
According to Cancer Council Queensland CEO Chris McMillan, prostate cancer is the most common cancer diagnosed in men in Australia. “Around 18,300 men are diagnosed with prostate cancer every year in Australia,” she said, “and about 3200 die from the disease.”
Robot-assisted surgery for prostate cancer has been rapidly adopted by health professionals and is now the most widely utilised surgical approach for prostatectomy. Yet according to Dr Nigel Dunglison from the Royal Brisbane and Women’s Hospital, very little research has been done comparing long-term outcomes of robotic-assisted prostatectomy and open prostatectomy.
With this in mind, a research team led by the Royal Brisbane and Women’s Hospital and Griffith University’s Menzies Health Institute Queensland decided to examine surgery outcomes for around 300 Australian men over a two-year period. Their work was funded by Cancer Council Queensland and published in The Lancet Oncology.
“Our study showed similar results for urinary and erectile function from both the robot-assisted and open surgical patient groups after 12 weeks, and these remained equal at six, 12 and 24 months,” Dr Dunglison said. Men who underwent a robotic prostatectomy also had a lower biochemical prostate-specific antigen (PSA) recurrence after two years; however, the reason for this was not specifically studied and more research is needed to understand why.
Dr Dunglison acknowledged that many patients experience long-term complications post-surgery, including reduced urinary and bowel control, erectile dysfunction and elevated psychological distress. He and his fellow researchers thus “recommend that funding organisations, healthcare institutions and practitioners embrace minimally invasive technologies, and high-quality training is provided for surgeons to ensure patients receive the best form of care”.
Menzies Health Institute Queensland Director Professor Suzanne Chambers added that one in five study participants reported elevated psychological distress 24 months after surgery — a side effect that was not influenced by surgery type. The findings thus highlight the need for improved distress screening and psychological care long after treatment ends, she said.
“Issues such as sexual dysfunction, urinary and bowel changes, and even fear of recurrence, can all lead to elevated psychological distress,” Professor Chambers continued.
“For optimal prostate care, there needs to be evidence-based psychological intervention that is responsive to masculinity and related concerns.”
The Chairman of the Prostate Cancer Foundation Australia (PCFA), Jim Hughes AM, said the foundation welcomes the findings and embraces their dissemination to men diagnosed with localised prostate cancer in order to support informed decision-making.
“There are various other treatments available and men need to be well across their medical choices so that optimal decisions relevant to their personal health circumstances can be made by them in conjunction with their medical advisors,” Hughes said.
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