R.A.L.P. vs. Open radical

Different studies will naturally result in slightly different outcomes…taken broadly, however, there is no compelling data to suggest that RALP is better or safer than open surgery or LRP.   If you consider these to be benefits, however, there are several differences in the use of RALP as compared to open surgery for treatment of localized prostate cancer.   Less blood loss during surgery, a shorter hospital stay, faster post-surgical recovery, and less need for post-surgical pain management. It is generally said that the quality of outcome after radical prostatectomy has little to do with the technology being used and everything to do with the skill, expertise, and focus of the individual surgeon who does the operation.   In the words of Dr Eric Klein:   "The most important factor in ensuring the best chance for cure and good functional outcomes after radical prostatectomy is the experience of the surgeon and not what approach is used. My best advice is to find the most experienced surgeon you can and let him choose the surgical tools that work best in his hands."      

I join in that opinion. Find the best surgeon you can and let him to the surgery the way he does it best. Having said that, I chose open surgery. open takes less OR time, does not require that you are pumped full of CO2, and does not involve entering the peritoneal cavity. I was out of the hospital in less than 24 hours and experienced very little blood loss.

Good luck with your decision and do not hesitate to ask all the questions you can. There are very knowledgable guys here who are happy to help.

I agree with the previous posters.

Casey59 said...
Different studies will naturally result in slightly different outcomes…taken broadly, however, there is no compelling data to suggest that RALP is better or safer than open surgery

I agree.

Casey59 said...
If you consider these to be benefits, however, there are several differences in the use of RALP as compared to open surgery for treatment of localized prostate cancer. <span style="mso-spacerun: yes"> Less blood loss during surgery, a shorter hospital stay, faster post-surgical recovery, and less need for post-surgical pain management.

Less blood loss during surgery I buy but, while they are frequently claimed by RALP proponents, I do not believe there is conclusive evidence for shorter hospital stay, faster post-surgical recovery, or less need for post-surgical pain management.

Here, for instance, is a recent study from Hopkins discussing changes in length-of-stay over the last 20 years that concludes that "RALRP appears to result in a higher proportion of 'off-pathway' [greater than 3 day stay] patients, primarily due to ileus, compared with RRP and LRP"

I have seen some evidence of faster return to continence with robotic but, again, I don't know if that is conclusive.

Yup, the SKILL of the surgeon is what is most important -- by far!

All things being equal, skill-wise, the cure rate between robotic and open is about the same.

All things still being equal, I would definitely prefer robotic over open because the recovery period is a bit less, less pain involved, very little loss of blood during surgery as compared to open, etc.

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Danch W,

Without a signature, I am not sure why you pose the question. I assume you have PCa and are considering treatment options. If that is the case, we need to know more about your situation and the advise you have received. I trust also that you are not limiting your treatment choice to surgery as it is not always the best method.

For instance in my case two different surgeons and a medical oncologist said I would be ill served by surgery due to my risk level. So a comparisson between open, LRP, or LARP would have been a waste of time. Depending on your risk level, brachytherapy (both permanent seeds and High Dose Rate and IMRT/IGRT) have proven to be more effective than surgery for cancer control with less initial risk and fewer side effects. I suggest all options bear studying as there is no "one best" treatment. All have risks and side effects and varying degrees of cancer control.

I can tell you that having used radiation (HDR brachytherapy and IMRT) that I was not hospitalized, lost no blood, never had a catheter for more than four hours, was never incontinent, and have not had ED from the radiation treatment.

As with surgery, radiation treatment is an acquired skill and you need to seek clinics that specialize in prostate cancer radiation. I look forward to learning more about your specifics so we can be of more value to you.

Jack