Laparoscopy May Have Limited Role In Prostate Cancer

NEW YORK--Initial enthusiasm accompanying the introduction oflaparoscopy in the diagnosis and treatment of prostate cancerhas given way to a more realistic assessment of its value, R.Ernest Sosa, MD, said at a conference on prostate cancer at LenoxHill Hospital. It continues to have value, but its role is limitedand is unlikely to broaden.

Dr. Sosa, associate professor of urology at Cornell UniversityMedical College, praised laparoscopy as a tool in staging as wellas dissection when lymph node metastases have been identified.He cautioned, however, that laparoscopy should be done only whenthere is a high likelihood of node involvement.

In selected patients, laparoscopy offers as advantages shorterhospital stay, lower costs (because of shorter stay), rapid convalescence,and reduced morbidity, compared with conventional surgery. Onthe down side, however, the procedure adds about 2 hours to surgicaltime and requires special expertise, making it a more expensiveoperation to perform.

The key to using laparoscopy effectively, Dr. Sosa said, liesin patient selection. Patients with T1a and T1b disease are notgood candidates because of the lower likelihood of positive nodes.In patients with later stage disease and high Gleason scales,the value of laparoscopy increases.

The complication rate has improved from 15% in 1991 to 6% today,and the time required to perform the procedure has been reduced,he noted.