International experts in urologic oncology, prostate cancer surgery and health outcomes recently met at City of Hope to make recommendations about best practices in robotic prostate surgery.

Conference attendees systematically reviewed the world’s literature on robotic-assisted radical prostatectomy, assessing patient selection and surgical techniques, cancer control, and outcomes and complications.

City of Hope hosted a conference aimed at defining best practices in robotic prostate surgery. (Photo by p.cunningham)

Recommendations from the September conference will result in new consensus guidelines for prostate cancer surgery and will touch on topics including cancer recurrence and quality of life. The guidelines will be developed for managing prostate cancer with robotic surgery based on assessment of the technique’s use since 2001, when the U.S. Food and Drug Administration approved Intuitive Surgical Inc.’s da Vinci Surgical System for prostate surgery.

According to Timothy Wilson, M.D., Pauline and Martin Collins Family Chair in Urology and director of City of Hope’s Prostate Cancer Program, most surgeons treating prostate cancer a decade ago used an open-surgery approach called the radical retropubic prostatectomy to remove the prostate gland. But today, robotic-assisted radical prostatectomy has become the dominant technique: In the U.S., more than 75 percent of radical prostatectomies are performed robotically.

Only a few prospective studies or randomized trials have compared robotic-assisted radical prostatectomy’s outcomes to those in open surgery. Conference attendees analyzed the data to provide guidelines for attaining the best results. Guidelines also will help novice robotic surgeons and those with less experience use the best possible techniques for controlling cancer while minimizing complications.

“Not only is it our goal to develop a white paper on best practices,” said Wilson, who co-chaired the meeting, which was sponsored by the Division of Urology and Urologic Oncology and organized by the New England Research Institute (NERI). “Eventually, we would like to use the guidelines that are developed from the conference to provide a framework for an accredited, Web-based continuing medical education training course for physicians worldwide on robotic prostate surgery.

“In addition, we hope that important clinical and research questions will be inspired by the panel’s review, stimulating new multicenter randomized trials.”

Conference co-chairs included Ray Rosen Ph.D., of NERI; Francesco Montorsi, M.D., of the University of Vita-Salute San Raffaele in Milan, Italy, and Alexandre Mottrie, M.D., of the Onze-Lieve-Vrouwziekenhuis Robotic Surgery Institute in Aalst, Belgium.