International Journal of Clinical Oncology

, Volume 23, Issue 2, pp 347–352 | Cite as

Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer

  • Takashi Kobayashi
  • Kent Kanao
  • Motoo Araki
  • Naoki Terada
  • Yasuyuki Kobayashi
  • Atsuro Sawada
  • Takahiro Inoue
  • Shin Ebara
  • Toyohiko Watanabe
  • Tomomi Kamba
  • Makoto Sumitomo
  • Yasutomo Nasu
  • Osamu OgawaEmail author
Original Article



Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP).


We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment.


Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791).


Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.


Prostate cancer Robot-assisted radical prostatectomy Treatment choice Patient preference Expectant management 



This study was supported in part by a grant-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology, Japan (to O.O., #26253078). The authors allow the journal to review our data if requested.

Compliance with ethical standards

Conflict of interest

No author has any conflict of interest.


  1. 1.
    GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. IARC Publications 2012Google Scholar
  2. 2.
    Gray PJ, Lin CC, Cooperberg MR et al (2017) Temporal trends and the impact of race, insurance, and socioeconomic status in the management of localized prostate cancer. Eur Urol 71:729–737CrossRefPubMedGoogle Scholar
  3. 3.
    Neuner JM, See WA, Pezzin LE et al (2012) The association of robotic surgical technology and hospital prostatectomy volumes: increasing market share through the adoption of technology. Cancer 118:371–377CrossRefPubMedGoogle Scholar
  4. 4.
    Miller AB (2007) Commentary: implications of the frequent occurrence of occult carcinoma of the prostate. Int J Epidemiol 36:282–284CrossRefPubMedGoogle Scholar
  5. 5.
    Yaxley JW, Coughlin GD, Chambers SK et al (2016) Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 388:1057–1066CrossRefPubMedGoogle Scholar
  6. 6.
    Barbash GI, Glied SA (2010) New technology and health care costs—the case of robot-assisted surgery. N Engl J Med 363:701–704CrossRefPubMedGoogle Scholar
  7. 7.
    Sugihara T, Yasunaga H, Horiguchi H et al (2014) Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012–2013. Cancer Sci 105:1421–1426CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Jacobs BL, Zhang Y, Schroeck FR et al (2013) Use of advanced treatment technologies among men at low risk of dying from prostate cancer. JAMA 309:2587–2595CrossRefPubMedGoogle Scholar
  9. 9.
    National Comprehensive Cancer Network Practice Guidelines in Oncology. 2017. Accessed 1 Aug 2017
  10. 10.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383CrossRefPubMedGoogle Scholar
  11. 11.
    ASA Physical Status Classification System. 2014. Accessed 1 Aug 2017
  12. 12.
    van As NJ, Norman AR, Thomas K et al (2008) Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance. Eur Urol 54:1297–1305CrossRefPubMedGoogle Scholar
  13. 13.
    Soloway MS, Soloway CT, Eldefrawy A et al (2010) Careful selection and close monitoring of low-risk prostate cancer patients on active surveillance minimizes the need for treatment. Eur Urol 58:831–835CrossRefPubMedGoogle Scholar
  14. 14.
    Klotz L, Zhang L, Lam A et al (2010) Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer. J Clin Oncol 28:126–131CrossRefPubMedGoogle Scholar
  15. 15.
    van den Bergh RC, Roemeling S, Roobol MJ et al (2009) Outcomes of men with screen-detected prostate cancer eligible for active surveillance who were managed expectantly. Eur Urol 55:1–8CrossRefPubMedGoogle Scholar
  16. 16.
    Tosoian JJ, Trock BJ, Landis P et al (2011) Active surveillance program for prostate cancer: an update of the Johns Hopkins experience. J Clin Oncol 29:2185–2190CrossRefPubMedGoogle Scholar
  17. 17.
    Kamidono S, Ohshima S, Hirao Y et al (2008) Evidence-based clinical practice Guidelines for Prostate Cancer (Summary—JUA 2006 Edition). Int J Urol 15:1–18CrossRefPubMedGoogle Scholar
  18. 18.
    Bul M, Zhu X, Valdagni R et al (2013) Active surveillance for low-risk prostate cancer worldwide: the PRIAS study. Eur Urol 63:597–603CrossRefPubMedGoogle Scholar
  19. 19.
    Kakehi Y, Kamoto T, Shiraishi T et al (2008) Prospective evaluation of selection criteria for active surveillance in Japanese patients with stage T1cN0M0 prostate cancer. Jpn J Clin Oncol 38:122–128CrossRefPubMedGoogle Scholar
  20. 20.
    Schroeck FR, Kaufman SR, Jacobs BL et al (2013) Technology diffusion and diagnostic testing for prostate cancer. J Urol 190:1715–1720CrossRefPubMedGoogle Scholar
  21. 21.
    Jemal A, Fedewa SA, Ma J et al (2015) Prostate cancer incidence and PSA testing patterns in relation to USPSTF screening recommendations. JAMA 314:2054–2061CrossRefPubMedGoogle Scholar
  22. 22.
    Fleshner K, Carlsson SV, Roobol MJ (2017) The effect of the USPSTF PSA screening recommendation on prostate cancer incidence patterns in the USA. Nat Rev Urol 14:26–37CrossRefPubMedGoogle Scholar
  23. 23.
    Tsukamoto T, Tanaka S (2015) Robot-assisted laparoscopic radical prostatectomy for patients with prostatic cancer and factors promoting installation of the robotic surgical equipment-questionnaire survey. Hinyokika Kiyo 61:321–328PubMedGoogle Scholar
  24. 24.
    Novara G, Ficarra V, Rosen RC et al (2012) Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 62:431–452CrossRefPubMedGoogle Scholar
  25. 25.
    Takizawa I, Ohori M, Ohno Y et al (2016) Pathologic and prognostic outcomes of very low- and low-risk prostate cancer according to the National Comprehensive Cancer Network Guidelines in Japanese Patients with Radical Prostatectomy. J Cancer Ther 7:239–246CrossRefGoogle Scholar
  26. 26.
    Sugihara T, Yasunaga H, Matsui H et al (2017) Accessibility to surgical robot technology and prostate-cancer patient behavior for prostatectomy. Jpn J Clin Oncol 47(7):647–651CrossRefPubMedGoogle Scholar
  27. 27.
    Tsukamoto T, Tanaka S (2016) Have case loads of radical surgery for prostate cancer been concentrated in hospitals with robotic equipment?—analyses with questionnaire survey and diagnostic procedure combination (DPC) data. Hinyokika Kiyo 62:179–185PubMedGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2017

Authors and Affiliations

  • Takashi Kobayashi
    • 1
  • Kent Kanao
    • 2
  • Motoo Araki
    • 3
  • Naoki Terada
    • 1
    • 4
  • Yasuyuki Kobayashi
    • 3
  • Atsuro Sawada
    • 1
  • Takahiro Inoue
    • 1
  • Shin Ebara
    • 3
  • Toyohiko Watanabe
    • 3
  • Tomomi Kamba
    • 1
    • 5
  • Makoto Sumitomo
    • 2
  • Yasutomo Nasu
    • 3
  • Osamu Ogawa
    • 1
    Email author
  1. 1.Department of UrologyKyoto University Graduate School of MedicineKyotoJapan
  2. 2.Department of UrologyAichi Medical UniversityNagakuteJapan
  3. 3.Department of UrologyOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
  4. 4.Department of UrologyMiyazaki UniversityMiyazakiJapan
  5. 5.Department of UrologyKumamoto University Graduate School of MedicineKumamotoJapan

Personalised recommendations