A few good studies exist looking at open versus<unk>  versus<unk>  and robotic<unk>  prostatectomy in cancer as of 2011. There is a robotic and non robotic version. These two versions have unclear differences in cancer related outcomes The American Cancer Society states that success with<unk>  technique is determined by surgeon experience and focus. There is a long learning curve for the robotic procedure. It is estimated that about 60 cases need to be performed by a surgeon to be comfortable with the procedure and about 250 cases to be an expert. The procedure takes at least five hours and as long as eight hours for the average urologist, without a bilateral lymph node dissection, compared to 2.5–3 hours when done by an open technique with an incision, with a completed lymph node dissection. There is a greater risk of accidentally incising into the prostate, resulting in "margin positivity," i.e. leaving cancer within the patient, in otherwise organ confined disease, even in the hands of experts. This is presumed to happen as a result of the lack of tactile sensation. Margin positivity is strongly correlated with PSA recurrences and a fourfold annual increase in cancer recurrence compared to men with negative surgical margins. There was a recent study from the University of Michigan by Hollenbeck et al. (Urology 2007; 70: 96-100) after their first 200 cases that they were able to eliminate extensive positive margins (12% in their first 15 cases versus 2% after performing 81 cases) but they continued to have a positive surgical margin rate of 22%. Their conclusion was "It seems that cumulative surgeon volume beyond that which can be obtained in the typical urology practice may be needed to obtain ideal margin rates with this new technology."Patrick C. Walsh M.D in an editorial comment in the Journal of Urology, commenting on this article, compared his own experience at Johns Hopkins with organ confined disease with a positive surgical margin rate of only 1.8%. Another problem in higher-risk cases is that many surgeons using the robotic technique do not perform a lymph node dissection, as it is difficult to perform this adequately, robotically. The rationale usually given is that patient selection is such that most patients with Gleason score 6 on pathology do not need a lymphadenectomy. However, a small number of patients with Gleason 6 adenocarcinoma of the prostate are upgraded to Gleason 7 on final pathology. Any micrometastases in lymph nodes would not be detected, not be removed and would increase the risk of recurrences. There has not been any evidence in the urologic literature showing a benefit in regard to continence, potency or cure rates with the robotic procedure. Interest in the procedure is often patient driven, by patients who have been led to believe by the extensive advertising, that there are significant benefits to be obtained from the procedure. The open<unk>  prostatectomy is still the "gold standard."
Laparoscopic radical prostatectomy
Transurethral resection of the prostate
Transurethral needle ablation of the prostate
Radical perineal prostatectomy
Radical retropubic prostatectomy
Transurethral incision of the prostate
Prostatic stent
Prostatic artery embolization