Robotic Prostatectomy May Be Overused for Cancer Treatment: Study

Despite ongoing debate over the effectiveness of robotic surgery to treat prostate cancer, an increasing number of doctors are using advanced technologies like robotic prostatectomy, according to new research.  

In a study published in the Journal of the American Medical Association (JAMA) on June 26, researchers from the University of Michigan indicate that the use of robotic prostatectomy and intensity-modulated radiotherapy (IMRT) to treat prostate cancer increased significantly from 2004 to 2009, even though it has not been proven that the techniques are safer or more effective than traditional treatment options.

One of the fastest growing advance technologies being used to treat prostate cancer is the da Vinci robotic surgical system, which is a complex robot that has been aggressively marketed by the manufacturer as a means of providing less invasive surgery, which reduces recovery time.

The da Vinci surgery robot is remotely controlled by a surgeon looking at a virtual reality representation of the patient’s internal organs, which is able to manipulate the four metal arms of the robot with hand and foot controls.

Since it was introduced in 2000, use of the da Vinci robot-assisted surgical system has increased dramatically throughout the United States. However, concerns have also emerged about whether the long-term benefits justify the increased costs and a number of severe complications following robotic surgery have been reported, including internal burns, tears and other injuries.

Earlier this year, the FDA launched a probe into the safety of the da Vinci surgical robot, sending a survey out to surgeons asking for information on training and reports of problems that developed following robotic prostatectomies, hysterectomies and other procedures. The manufacturer of the da Vinci system, Intuitive Surgical, also faces dozens of robotic surgery lawsuits that allege the company failed to provide adequate training for surgeons or warnings about the risk of problems that may be caused by the machine.

The other advanced technology examined in the JAMA study is intensity-modulated radiotherapy (IMRT), which uses beams of radiation precisely aimed to destroy tumors and spare healthy tissue.

The researchers reviewed Medicare patient data to track the increased use of the robotic surgery and IMRT. They found that use increased overall for patients at a low risk of dying from prostate cancer, from 32% in 2004 to 44% in 2009. Among patients at a higher risk of prostate cancer death, use of advanced technology increased even more significantly; from 36% to 57% in the same time period.

While the newer treatments have not been shown to be more effective, they have been shown to be more expensive. Hospitals starting an IMRT or da Vinci robot treatment program can expect to spend about $2 million just to get the program running. Once operation, they can cost hundreds of thousands of dollars annually to maintain and can add thousands of dollars per surgery.