Surgical treatment of prostate cancer: what to do?

Although there is a paucity of prospective studies comparing surgical treatment of prostate cancer to other treatments, surgical treatment is usually recommended for men with a good chance for cure who have ten or more years life expectancy. Proper selection of men undergoing surgery is critical to achieve cures and minimize side effects. Laparoscopic and robotic prostatectomy have become the predominant approach for surgery despite a very slow learning curve, greater expense, and higher dissatisfaction rates compared to more traditional approaches. Outcomes using a laparoscopic or robotic approach are equivalent to open methods only after 250 to 1000 procedures. In this era of increasing medical costs, utilization of robotic and laparoscopic approaches to prostatic cancer surgery needs to be critically examined.