Health Buzz: Robotic Prostate Surgery Doubts and Other Health News

By Megan Johnson

Posted: October 14, 2009

Study Says Minimally Invasive Prostate Cancer Surgery Carries Risk

A new study of close to 9,000 men suggests that minimally invasive, robot-assisted surgery to remove the prostate carries a higher risk of impotence and incontinence than traditional surgery, HealthDay reports. The newer surgery's advantages include a shorter average hospital stay, a smaller incision, and a smaller chance of post-op complications, the study found. But the study's author told HealthDay that benefits of the high-tech cancer surgery are being too heavily touted, especially via direct-to-consumer ads that have fueled patient demand. The robot-assisted surgery carries a 4.7 percent risk of complications such as impotence and incontinence, compared with 2.1 percent with standard surgery, the study found. That raises the question of whether the benefits outweigh the risks. The study appears in the Journal of the American Medical Association.

[Read Exercise May Prevent Prostate Cancer and Getting Closer to the Origins of Prostate Cancer.]

Why 1 in 4 Early-Stage Breast Cancer Patients Still Opt for Mastectomies

For more than 20 years, breast cancer patients have been overtreated with mastectomies, experts contend, instead of receiving breast-sparing surgery that removes just the lump and a little of the surrounding tissue. But a new survey of 2,000 women shows that about 75 percent of those who qualify for breast-conserving surgery are getting it.

The study, published in the Journal of the American Medical Association, found that for those who still opted for total breast removal, the decision was sometimes based on a surgeon's recommendation and sometimes made against medical advice, U.S. News's Deborah Kotz reports. In fact, nearly 9 percent of breast cancer patients opted to get a mastectomy when their doctors didn't state a preference or favored breast-conserving surgery. "Our findings suggest that patient preferences play an important role in initial receipt of mastectomy, especially in the absence of a surgeon recommendation favoring one procedure over another," wrote the study's authors. Read more.

[Read What You Can Do to Find the Cause of Breast Cancer and 4 Steps to Take Now to Lower Your Breast Cancer Risk.]

5 Common Popular Psychology Myths

Opposites attract. . . . We use very little of our brainpower. . . . American culture teems with commonly accepted pop-psych beliefs. They're embedded in TV and radio talk shows, self-help books, websites, movies, magazines, and, of course, everyday conversation, U.S. News's Lindsay Lyon writes.

In a new book, 50 Great Myths of Popular Psychology, Scott Lilienfeld and his coauthors explore the gulf between what millions of people say is so and the truth. While some of these myths are just plain fascinating, others may lead to bad decisions with unfortunate consequences. Lyon spoke with Lilienfeld about five of the myths exposed in the book. On the list: That in romantic relationships, opposites attract. Not only do opposites not attract, but being too different from a partner in personality, beliefs, and attitude is a good predictor of a future breakup, says Lilienfeld. For the most part, similarities attract. Pairing up with someone who is a yin to your yang may make life more exciting in the short run, but it's unlikely to be a recipe for long-term love, he says. Read more.

[Read 7 Myths about Narcissism and Narcissistic Personality Disorder and 7 Ways Your Siblings May Have Shaped You.]

Other Popular Articles from USNews.com

open vs robotic prostatectomy

The study that was done was a statistical analysis of the Medicare data base that does effective evaluate clinical outcomes. Some of the data points are easier to make sense of than others. Length of stay and blood transfusion rates are reliably represented by the database as is ancillary treatment like radiation therapy. Other clinical outcomes are less easily assessed by the database which merely tracks the codes used to report diagnoses. While incontinence and erectile dysfunction codes seem to be more prominently reported following robotic prostatectomy, the procedures reported to treat those complications were more similar in both groups.

As a urologist who has done both procedures, the incontinence and erectile dysfunction outcomes are quite similar for both and in my practice, I will report incontinence and erectile dysfunction in almost all patients following either procedure because most men have some degree of incontinence following surgery that will generally resolve in 3-6 months. It resolves, but I will mark the code because the condition is present and visit complexity level and charges are partially based on the number of problems a patient has. The same goes for ED. Most men have some degree of ED following prostatectomy of any type and will potentially recover function as far out as 2 years from treatment.

I think the medicare data underestimates the overall incidence of incontinence and erectile dysfunction at any point following both procedures and I give that portion of the study results little credence. I think the data points that I think are most reliable in this particular analysis tend to favor robotic prostatectomy over open prostatectomy, but when I talk to my patients, I tell them that the only advantages that has data to support them are the reduce rate of blood transfusion, length of hospital stay and recovery otherwise outcomes are going to be essentially the same. I think a reduction in blood transfusion from 20% - 2% is a significant improvement. You recover much more quickly when you leave the hospital with a hemoglobin level of 12 than you do with a hemoglobin level of 8.

John Wrenn of NC @ Oct 14, 2009 19:35:50 PM

borrrrrringggggggggg

this subject is sooooooooo freaking boring

maxxy of KY @ Oct 14, 2009 18:41:30 PM

Prostate Cancer

Any discussion of a Radical Prostatectomy (RP) is incomplete without mentioning two common side effects of this treatment; Peyronies Disease (PD) and penile shortening. PD, for which there is no satisfactory treatment, results from formation of penile scar tissue, makes intercourse difficult or impossible and usually causes loss of penile length and girth. (Penile shortening may also occur independent of PD). In the July 2008 edition of Medical News Today, it was reported that almost 20% of men developed PD after removal of their prostate. In a recent study, men who underwnt a RP (whether robotically assisted or open) were woefully ignorant of these side effects, but those in the robotically assisted category had the most unrealistic expectations.

When I developed PD, I was unaware that a disease like this even existed. In frustration, I started an informational website, www.curepeyronies.net. Every email I get describes a man in a desperate situation with nowhere to turn. Urologists must do a better job of informing their patients of these common side effects so they will be able to give informed consent before undergoing surgery.

David of NY @ Oct 14, 2009 15:38:48 PM

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