Trends in treatment for localized prostate cancer after emergence of robotic-assisted laparoscopic radical prostatectomy in Taiwan

Abstract

Background: Radical retropubic prostatectomy remains the gold standard treatment for localized prostate cancer. However, new minimally invasive techniques have emerged, providing a less invasive approach. Robotic-assisted laparoscopic radical prostatectomy is the ideal technique, providing good oncologic and functional outcomes. We analyzed the impact of robotic surgical systems on practice patterns among urologists to explain changes in the value of radical retropubic prostatectomy, laparoscopic radical prostatectomy and robotic-assisted laparoscopic radical prostatectomy in a single institution in Taiwan.

Methods: We retrospectively reviewed the records of patients who received prostatectomy by one of the above procedures between January 2004 and November 2009. Decisions to perform these procedures were made by patient preference. Patients who received prostate biopsies at other hospitals were transferred to our hospital specifically for robotic-assisted prostatectomy.

Results: A total of 434 radical prostatectomies were performed, of which 141 (32.49%) were radical retropubic prostatectomies, 59 (13.59%) were laparoscopic radical prostatectomies and 234 (53.92%) were robotic-assisted laparoscopic prostatectomies. The overall number of prostatectomies has increased over time because of an increase in robotic-assisted procedures. No decreases were seen in the number of radical retropubic prostatectomies during the evaluation period. Changes in the ratio of robotic-assisted prostatectomies compared to radical retropubic and laparoscopic radical prostatectomies demonstrated a trend toward robotic-assisted procedures. The percentage of cases transferred from other hospitals also increased over time from 28.57% to 68.60%.

Conclusion: Our experience emphasizes the potential of robotic-assisted prostatectomy to become the mainstream treatment for localized prostate cancer in Taiwan.