One in five men who undergo the surgery to treat cancer later regrets the decision. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.
The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven't necessarily translated to better results.
Patients who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy (RALP) between 2000 and 2007 were mailed cross-sectional surveys by a Duke University team and the questions covered socio-demographic information, the Expanded Prostate Cancer Index Composite (EPIC) and sought to elicit the satisfaction or regret levels.
The Expanded Prostate Cancer Index Composite (EPIC) is a comprehensive instrument designed to evaluate patient function and bother after prostate cancer treatment.
Duke University researchers surveyed 400 men with early prostate cancer who had undergone either a traditional "open" surgical procedure or newer robotic surgery to remove the prostate. Overall, the vast majority of men were satisfied. However, 19 percent regretted their treatment choice. Notably, men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure.
Researchers say the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative surgery than traditional prostatectomy. Even among men who had the same scores on erectile function and other measures of post-surgery recovery, the robotic patients still reported a higher level of dissatisfaction and regret than other men.
They said, "We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counseling to minimize regret and maximize satisfaction."
The report adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer, notes Tara Parker-Pope, writing in New York Times.
Of the 219,000 men in the United States who learn they have prostate cancer each year, nearly half undergo surgical removal of the gland, according to the National Cancer Institute.
Part of the problem may be that doctors who perform robotic prostatectomies commonly cite potency rates as high as 95 percent and above among their patients, giving patients an unrealistic view of life after surgery.
But the data are highly misleading. Researchers often define potency as simply being able to achieve an erection that is "adequate" for intercourse — but for many men, that definition doesn't capture their ongoing struggle to return to a normal sex life. Earlier this year, researchers from George Washington University and New York University used a more realistic definition of potency, showing that after surgery, fewer than half of the men studied felt their sex lives had returned to normal within a year.