From “European Urology” Dec., 2014: Australian study where a very experienced Open Radical Prostatectomy surgeon (over 3000 cases—certainly familiar with the anatomy) did 686 open RP’s and 866 Robotic RP’s. Examining the comparison of complications (incontinence, ED, inadequate cancer control) between the 2 types of operations, it took the surgeon 600-800 Robotic cases to match or exceed the complication rates for open RP. The message was that Robotic Prostatectomy was more appropriate for high volume surgeons and not for late career or low volume surgeons. This reiterates warnings by the American Urology Association that low volume surgeons should not quote high volume surgeons’ complication rates. It is also why the FDA is reevaluating the training protocols for the DaVinci Robot (too many complications). Since low volume surgeons typically do 1-4 cases/month, the learning curve to 600-800 cases is practically insurmountable.
From AUA Daily Scope (on line news magazine) and reported in the journal “Cancer” Jan. 2015
Early mild GI toxicity: IMRT 86.2% Proton Beam 95.7%
Late (chronic) moderate to severe GI toxicity: IMRT 10.8% Proton Beam 12.8%
Early mild Bladder toxicity: IMRT 71.2% Proton Beam 78.7%
Late (chronic) moderate to severe Bladder toxicity: IMRT 18.3% Proton Beam 12.8%
These numbers are worse than I previously believed. Radiation is NOT a free ride.
The most appropriate prostate cancer for radiation remains the big bulky tumor. Men under 75 years old who are recommended to have radiation for small tumors might ask if their doctor has an ownership interest in the radiation unit.