RARP Prostate Cancer Surgery Causes Fewer Urinary, Sexual Problems Than Brachytherapy, Italian Study Finds

RARP Prostate Cancer Surgery Causes Fewer Urinary, Sexual Problems Than Brachytherapy, Italian Study Finds

Men with low-risk prostate cancer have similar recurrence-free survival rates when treated with surgical robotic prostatectomy or brachytherapy, but those who received surgery had fewer urinary or sexual problems two years after treatment, a randomized trial in Italy has concluded.

The study, “Robotic prostatectomy versus brachytherapy for the treatment of low-risk prostate cancer,” appeared in the Canadian Journal of Urology.

Treatment of early-stage or low-risk prostate cancer relies on active surveillance, surgery or radiation therapy. In particular, both robot-assisted radical prostatectomy (RARP) and brachytherapy (BP) — a type of internal radiation therapy in which radioactive seeds are placed inside or near a tumor — have been shown to effectively treat prostate cancer. However, until now little was known about their long-term effects.

“Treatment decisions that men with low-risk prostate cancer have to make can be difficult, as a lot of it depends on what the patient is looking for and what type of experience their physician has to offer,” Dr. David Samadi, chairman of urology and chief of robotic surgery at New York’s Lenox Hill Hospital, said in a press release.

Italian researchers at Milan’s San Paolo Hospital conducted the single-center, prospective study from January 2012 to January 2016 to compare the outcomes of 165 patients randomly assigned to receive either RARP or BT. They followed all patients for up to two years after treatment, including clinical evaluation and determination of prostate-specific antigen (PSA) levels.

Researchers also evaluated urinary and erectile functions, and found that overall biochemical recurrence-free survival rates were similar among the two groups. Patients undergoing RARP had a 97.4 percent recurrence-free survival rate, compared to 96.1 percent reported in the BT-treated group. Biochemical recurrence is the term used when a patient’s PSA levels start rising again.

“This was actually expected,” said Samadi. “A two-year follow-up is a short period of time to ascertain much difference between the two procedures and there really needs to be further studies of a longer duration of time to get a better idea.”

While the recurrence-free survival was similar in both groups, researchers saw different outcomes when analyzing sexual or urinary symptoms.

Men undergoing BT regained continence faster than those who received RARP during the first six months of follow-up. But this difference was no longer significant after 12 months and 24 months. Interestingly, men in the BT group had more urinary symptoms during the two-year follow-up.

Regarding sexual function, both groups showed a decreased ability to maintain an erection right after treatment. However, RARP-treated men recovered potency much more quickly than their BP-treated counterparts. By the final follow-up, 90 percent of RARP-treated men were back to normal, compared to only 60 percent of men in the BT group.

“These are factors any doctor and the men they see with low-risk prostate cancer need to take into consideration when making any treatment decision,” Samadi said. “When they make the comparison between RARP and BT, RARP clearly shows the upper hand in treating prostate cancer effectively and managing symptoms better at this stage.”

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5 comments

  1. Lawrence Glickman says:

    Why did you not even mention the large and growing treatment options for prostate cancer? If the patient has organ confined early stage PC all practitioners should always inform the patient that there is HIFU,CRYO, Tookad, CYBER KNIFE, and more in Europe. BT and RS have been the standard but have no advantage in early stage results. The newer therapies have fewer side effects and shorter treatment times and are often less expensive. Patients are usually uniformed and take the offer made by their primary Doctor. This needs to change.

  2. Darryl Baillie says:

    I can’t believe this article…. Anyone that says “Regarding sexual function, both groups showed a decreased ability to maintain an erection right after treatment. However, RARP-treated men recovered potency much more quickly than their BP-treated counterparts. By the final follow-up, 90 percent of RARP-treated men were back to normal, compared to only 60 percent of men in the BT group.” is living in fairy land…There is no way that 90% of RARP patients are normal at 2,3 or 5yrs post op! This article smells like a Da Vinci advertisment.

    • Tim Bossie says:

      Hi Darryl, we can certainly understand your skepticism regarding this, but we are only reporting on what the study finds.

  3. Darryl Baillie says:

    Hi Tim
    The article states quite clearly that 90% who underwent RARP had “normal” sexual function at the end of two yrs… Samadi’s article in PRweb clearly uses the definition as “the ability to achieve and maintain satisfactory erections for sexual intercourse or potency, with or without the use of PDE-5 inhibitors.” From experience and active membership of many forums I can tell you the final result is marginal and far from normal or satisfactory. Be careful when summarising somebody elses article not to embellish perceived benefits. Using the word “normal” is clearly embellishing the final result. Here is an article from a forum you may wish to read…https://www.inspire.com/groups/us-too-prostate-cancer/discussion/after-rp-does-anyone-not-suffer-from-ed/?page=1#replies
    The conversation drifts a little but the theme is there…I understand 77% of men are impotent 2 yrs post surgery whether robotic or open surgery!! Samadi sells robotic surgery and his claims are amasing … I mean really amasing yet Sloan Kettering Memorial Hospital touts figures not too dissimilar to my understanding and they have the best of the best surgeons in the world.
    My surgeon told my wife and I that all his patients had return of function ..but maybe 1 in 200 did not. Later (about 3yrs) his practice released a video explaining the procedure and outcomes and it was explained that hardly any men had return of function at 2 yrs and they could offer a prosthesis…. get my drift??

    • Tim Bossie says:

      Hey Darryl, I get where you’re coming from. I am not doubting your statement in any way. I am simply highlighting the fact that we report on the findings of different studies and are not drawing any conclusions ourselves.

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