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da Vinci Procedures -
Treatment Comparison
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.
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Chart
1: Outcome Comparison:
Surgery vs. Radiotherapy
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Outcome
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Radical Prostatectomy*
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Radiation**
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Survival duration compared
to conservative disease
management1
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8.6 years
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4.6 years
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15-year prostate cancer
survival rate2
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92%
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87%
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Survival rate for high-grade
cancer patients3
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45% increase in overall
survival rate vs.
radiotherapy
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-
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Risk of cancer-specific
death for
high-grade cancer patients4
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49% less risk vs.
radiotherapy
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-
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Cancer recurrence5
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Easy to detect
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Difficult to detect
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Risk of rectal cancer
(Within 10 year follow-up)
6
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5.1 out of 1000
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10.0 out of 1000
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Risk of bladder cancer7
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0.8% developed bladder
cancer
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1.3% developed bladder
cancer
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Bowel function impairment8
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-
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Significantly greater vs.
surgery
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Disease-specific long-term
quality of life9
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Stable
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Unstable
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Painful urination (at 18
month follow-up) 10
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1% of patients
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30% of patients
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Long-term erectile
dysfunction11
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Lower risk
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Higher risk
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*Open surgery; comparable long-term data not yet
available on
da
Vinci® Prostatectomy.
**External
Beam Radiation Therapy (EBRT)
unless otherwise noted in the
citation.
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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.
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Chart 2: da Vinci® vs.
Open vs. Conventional
Laparoscopy
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Outcome
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da
Vinci©
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Open
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Lap
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Cancer control
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T2 margin status
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4.51
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5.92
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7.73
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Complications
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Estimated blood loss (EBL)
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109 ml4
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1355 ml5
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380 ml6
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Length of stay (LOS)
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1.2 days4
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3 days5
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2.5 days13
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Major
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1.7%4
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6.7%5
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3.7%6
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Minor
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3.7%4
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12.6%5
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14.6%6
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Urinary function
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3 month
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92.9%7
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54%8
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62%9
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6 month
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94.9%7
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80%8
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77%9
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12 month
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97.4%7
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93%8
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83%9
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Sexual function
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12 month
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86%10
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71%11
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76%12
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•
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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.
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