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MORE RISKS IN LESS-INVASIVE PROSTATE SURGERY

The study adds to the debate over prostate cancer treatment.

CHICAGO - A new study suggests less-invasive keyhole surgery for prostate cancer may mean a higher risk for lasting incontinence and impotence when compared with traditional surgery.

The results add to confusion around prostate cancer treatments, which sometimes lead to urinary and sexual problems. It's not clear that either kind of surgery is superior to radiation alone or watchful waiting, which means simply monitoring the prostate for changes.

Laparoscopic, or keyhole, surgery is increasingly chosen by men having a cancerous prostate removed. Often it involves the highly marketed da Vinci robotics system. Da Vinci's popularity has been rising even though there's never been a rigorous head-to-head comparison between it and standard surgery.

"There's been a rapid adoption of this relatively new technique," said the study's lead author, Dr. Jim Hu of Brigham and Women's Hospital in Boston.

For the study, appearing in today's Journal of the American Medical Association, researchers analyzed Medicare data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003-07. Of those, 1,938 patients had minimally invasive surgery and 6,899 patients had standard surgery. The data did not indicate how many of the less invasive cases involved robotics.

The patients who had keyhole surgery left the hospital in two days, rather than three, on average. They also had lower rates of blood transfusions, breathing problems and internal scarring.

There was no difference in the rate of additional cancer therapy down the road, suggesting the two techniques were about the same for cancer control.

But the men who had keyhole surgery were more likely to report complications in the first 30 days after surgery involving genital and urinary function. About 5 percent of the minimally invasive surgery patients vs. about 2 percent of the standard surgery patients had these complications. And after 18 months, they had more incontinence and erectile dysfunction.

Many doctors perform too few robot-assisted surgeries to get good at it, Hu said, and that could explain the lasting problems that showed up in the study. Previous research has shown doctors who perform the most surgeries get the best results.

Ryan Rhodes, a spokesman for Intuitive Surgical, said there have been more than 800 previous studies on robot-assisted prostate surgery. "The overwhelming majority of these show superior results," both for cancer treatment and urinary continence and sexual function, Rhodes said in an e-mail.

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