NEW YORK (Reuters Health) – While minimally invasive radical prostatectomy (MIRP) offers certain advantages over open retropubic radical prostatectomy (RRP), such as a shorter hospital stay, it also suffers from disadvantages, such as a higher rate of genitourinary complications, incontinence, and erectile dysfunction, new research shows.

As reported in the Journal of the American Medical Association for October 14, Dr. Jim C. Hu, from Brigham and Women’s Hospital, Boston, and colleagues compared the outcomes of 1938 MIRP- and 6899-RRP treated men with prostate cancer who were entered in the Surveillance, Epidemiology, and End Results Medicare database from 2003 to 2007. Men who underwent MIRP were more likely to be Asian, less likely to be black or Hispanic, and more likely to live in regions with higher educational levels and median incomes compared with men who underwent RRP.

The median hospital stay was shorter with MIRP than with RRP: 2.0 vs. 3.0 days (p < 0.001). In addition, MIRP-treated men were less likely to receive blood transfusions: 2.7% vs. 20.8% (p < 0.001). Postoperative respiratory complications (4.3% vs. 6.6%, p = 0.004), miscellaneous surgical complications (4.3% vs. 5.6%, p = 0.03), and anastomotic strictures (5.8% vs. 14.0%, p < 0.001) were all less likely in the MIRP group. By contrast, MIRP was associated with higher rates of genitourinary complications (4.7% vs. 2.1%, p = 0.001), incontinence (15.9 vs. 12.2 per 100 person-years, p = 0.02), and erectile dysfunction (26.8 vs. 19.2 per 100 person-years, p = 0.009). No significant difference in the use of additional cancer therapies was seen between MIRP and RRP (8.2 vs. 6.9 per 100 person-years). “In light of the mixed outcomes associated with MIRP, our finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard may be a reflection of a society and health care system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realize marketed or potential benefits during early adoption,” the authors conclude. Reference:
JAMA 2009;302:1557-1564.