General surgery

Robotic surgery for prostate cancer an increasingly popular treatment option is not proven as more effective, yet many patients believe that it is, a new UNSW and Ingham Institute study shows. An Australian-first study by a team at UNSW Medicine, the Ingham Institute and South Western Sydney Local Health District has shown that prostate cancer patients mistakenly believe that robotic surgery provides a more definitive cure for prostate cancer than other treatments.

Treatment options

The research published this week in Patient Education and Counselling  also found that patients often did not consider the different side effects of their treatment options  rather; they followed clinicians’ recommendations. The study authors say Australian men need to be better inform about all their treatment options before making a decision with significant consequences for their quality of life.

“There is ongoing debate over the best way to manage men with localised prostate cancer;” says Dr. Ben Smith, Co-Deputy Director of UNSW’s Centre for Oncology Education and Research Translation (CONCERT) at the Ingham Institute; who led the study. Men diagnosed with localised prostate cancer have several treatment options available to them.

Side effects

Much of the research to date has focused on the choice between open radical prostatectomy; radiotherapy and active surveillance; with little research specifically focused on considerations regarding robotic-assisted radical prostatectomy. “This is the first piece of research that specifically explores decision making in Australian men with localised prostate cancer considering robotic prostatectomy,” Dr. Smith says.

Robotic-assisted radical prostatectomy has been touted as a way of minimising side effects and has become increasingly popular. “Robotic prostatectomy is fast becoming the treatment of choice for many men; despite potentially high costs, and limited evidence supporting its superiority over other treatments;” Dr. Smith says.

That’s why the researchers want to understand why so many men diagnose with prostate cancer are choosing to have robotic prostatectomy  and how to support men in deciding which treatment option best suited their needs when robotic prostatectomy and radiotherapy were equally appropriate to offer them.

Shared decision making

In the study; 25 men recently diagnosed with localised prostate cancer completed semi-structured interviews asking about information and decision-making needs before and/or after attending a clinic in which they consulted a urologist and a radiation oncologist for treatment options.
The study revealed that most men preferred robotic prostatectomy over radiation therapy pre-clinic and chose it afterwards. Concerningly, they believed that robotic surgery provided a more definitive cure than radiotherapy; and they gave limited consideration to the differing side effects of robotic prostatectomy and radiotherapy.
“We found that men made decisions largely based on clinicians’ recommendations they trusted in clinicians and the information they provide to men is of course critical for treatment choice;” Dr. Smith says. “However; our study shows that men with localised prostate cancer need more balanced and complete information about robotic prostatectomy and radiotherapy; and they need it earlier in the process so that they can participate in shared decision making; as recommended by guidelines.”