77 COMPARATIVE EFFECTIVENESS OF PERINEAL VERSUS RETROPUBIC AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201177 COMPARATIVE EFFECTIVENESS OF PERINEAL VERSUS RETROPUBIC AND MINIMALLY INVASIVE RADICAL PROSTATECTOMY Sandip Prasad, Xiangmei Gu, Rebecca Lavelle, Stuart Lipsitz, and Jim Hu Sandip PrasadSandip Prasad Chicago, IL More articles by this author , Xiangmei GuXiangmei Gu Boston, MA More articles by this author , Rebecca LavelleRebecca Lavelle Boston, MA More articles by this author , Stuart LipsitzStuart Lipsitz Boston, MA More articles by this author , and Jim HuJim Hu Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.141AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While perineal radical prostatectomy (PRP) has been largely supplanted by retropubic (RRP) and minimally invasive radical prostatectomy (MIRP), it was the predominant surgical approach for prostate cancer for many years. Our population-based study objective was to compare utilization and outcomes for PRP vs. RRP and MIRP. METHODS We identified men diagnosed with prostate cancer from 2003-2005 who underwent PRP (n=452), MIRP (n=1,938), and RRP (n=6,899) from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data through 2007. We compared postoperative 30-day and anastomotic stricture complications, incontinence and erectile dysfunction (ED), and use of adjuvant cancer therapy (hormonal therapy and/or radiotherapy). RESULTS PRP comprised 4.9% of radical prostatectomies (RP) during our study period, with decreasing utilization over time (Figure 1). In propensity-score adjusted analyses, men undergoing PRP vs. RRP experienced shorter hospitalizations (median 2 vs. 3 days, p<0.001), fewer heterologous transfusions (7.2% vs. 20.8%, p<0.001), and required less additional cancer therapy (4.9% vs. 6.9%, p=0.020). When comparing PRP vs. MIRP, men undergoing PRP required more heterologous transfusions (7.2% vs. 2.7%, p=0.018), but experienced fewer miscellaneous medical complications (5.3% vs. 10.0%, p=0.045) and procedures for ED (1.4 vs. 2.3 per 100 person-years, p=0.008). The mean and median expenditures for PRP in the first six months post-operatively were $1,500 less than either RRP or MIRP (p<0.001) (Table). Medicare payments within 6 months of radical prostatectomy by surgical approach n Mean Median p-value All Medicare payments PRP 381 $11,953 $11,019 MIRP 1548 $14,939 $13,335 p RRP 5565 $14,301 $12,767 Prostate-cancer related Medicare payments⁎ PRP 381 $9,957 $9,339 MIRP 1548 $12,289 $11,324 p RRP 5565 $11,884 $10,853 ⁎ Medicare Payments associated with ICD-9 185.0. CONCLUSIONS Men undergoing PRP vs. RRP and MIRP experienced favorable outcomes associated with lower expenditures. Urologists may be abandoning an under-utilized, yet cost-effective surgical approach that compares favorably with its successors. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e33-e34 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sandip Prasad Chicago, IL More articles by this author Xiangmei Gu Boston, MA More articles by this author Rebecca Lavelle Boston, MA More articles by this author Stuart Lipsitz Boston, MA More articles by this author Jim Hu Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...