Comparing traditional and robotic-assisted surgery for prostate cancer

illustration outline of a hand against a blue background with a blue ribbon on the palm symbolizing prostate cancer research

An operation called a radical prostatectomy has long been a mainstay of prostate cancer treatment. Offered most often to men whose cancer has not yet begun to spread, it involves removing the entire prostate gland, and can be performed in different ways. With the traditional "open" method, surgeons remove the prostate through an 8-to-10-inch incision just below the belly button. Alternatively, surgeons can perform a robot-assisted radical prostatectomy. With this approach, miniaturized robotic instruments are passed through several much smaller incisions in the patient's abdomen. Surgeons control these instruments remotely while sitting at a console.

At least 85% of all radical prostatectomies in the United States today are performed robotically. But how do those high-tech surgeries compare with the traditional open method?

Most studies show no major differences between the procedures in terms of patient survival or their ability to control prostate cancer over the long term. Robotic prostatectomies ostensibly offer quality-of-life advantages for urinary function and sexual health. However, the supporting evidence comes mostly from doctors' reports, insurance claims-based data, or studies too small to generate definitive conclusions.

Now, results from a much larger comparative study provide needed clarity.

During the study, researchers from Harvard-affiliated hospitals and other academic medical centers in the United States followed 1,094 men who were treated with radical prostatectomy between 2003 and 2013. All the men had newly-diagnosed cancer that was confined to the prostate gland. Among them, 545 men had an open radical prostatectomy, while the remaining 549 men had a robot-assisted operation. Then at two-, six-, 12-, and 24-month intervals, the men responded to questions about their urinary and bowel functioning, ability to engage in sexual activity, energy levels, and emotional state.

What the study found

According to the results, both methods were equally effective at removing cancer from the body, and post-surgical complications between them occurred relatively infrequently. However, there were some short-term differences between the two approaches. For instance, the robotically-treated men had shorter lengths of hospital stay (1.6 days versus 2.1 days on average), and they also reported lower pain scores after surgery. Men who underwent robotically-assisted surgery also reported fewer complications such as blood clots (10 men versus three men), urinary tract infections (33 men versus 23 men), and bladder neck contracture, which is a treatable condition that occurs when scarring in the bladder outflow makes it hard to urinate. In all, 45 men experienced a bladder neck contracture after open surgery, compared to nine men treated with the robotic method.

"With regard to urinary and sexual health, there were no appreciable average long-term differences between the two approaches," said Dr. Peter Chang, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center in Boston, and the study's lead author, in an email. "This suggests that with high-volume providers in academic centers, quality-of-life outcomes between open and robotic prostatectomy are similar."

Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor of Harvard Health Publishing Annual Report on Prostate Diseases, agreed with Dr. Chang's conclusions. "This important study adds clarity to ongoing debates over the superiority of open versus robotic prostatectomy, and confirms little differences between the two methodologies, both in terms of patient satisfaction/outcomes and efficacy of cancer treatment," he said. "The skill and familiarity of the surgeon in performing either method of prostate removal by open or robotic approaches should guide the specific treatment choice."

Power your paddle sports with three great exercises

two kayaks and a paddle board on the beach adjacent to a lake

For my birthday last year, I received paddleboard lessons. I was always curious about the popular water sport and watched in fascination as people stood on almost-invisible boards, paddling along as if walking on water.

Paddleboarding was everything I expected and then some. Still, I quickly realized that it is a serious workout, like all paddle sports, such as kayaking and canoeing. It may look effortless, floating along and casually dipping a paddle in water. But much goes on beneath the surface, so to speak. As warmer weather beckons and paddle season arrives, it pays to get key muscles in shape before heading out on the water.

Tuning up muscles: Focus on core, back, arms, and shoulders

“Paddling a kayak, canoe, or paddleboard relies on muscles that we likely haven’t used much during winter,” says Kathleen Salas, a physical therapist with Spaulding Adaptive Sports Centers at Harvard-affiliated Spaulding Rehabilitation Network. “Even if you regularly weight train, the continuous and repetitive motions involved in paddling require endurance and control of specific muscles that need to be properly stretched and strengthened.”

While paddling can be a whole-body effort (even your legs contribute), three areas do the most work and thus need the most conditioning: the core, back, and arms and shoulders.

  • Core. Your core comprises several muscles, but the main ones for paddling include the rectus abdominis (that famed “six-pack”) and the obliques, located on the side and front of your abdomen. The core acts as the epicenter around which every movement revolves — from twisting to bending to stabilizing your trunk to generate power.
  • Back: Paddling engages most of the back muscles, but the ones that carry the most load are the latissimus dorsi muscles, also known as the lats, and the erector spinae. The lats are the large V-shaped muscles that connect your arms to your vertebral column. They help protect and stabilize your spine while providing shoulder and back strength. The erector spinae, a group of muscles that runs the length of the spine on the left and right, helps with rotation.
  • Arms and shoulders: Every paddle stroke engages the muscles in your arms (biceps) and the top of your shoulder (deltoids).

Many exercises specifically target these muscles, but here are three that can work multiple paddling muscles in one move. Add them to your workouts to help you get ready for paddling season. If you haven’t done these exercises before, try the first two without weights until you can do the movement smoothly and with good form.

Three great exercises to prep for paddling

Wood chop

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Muscles worked: Deltoids, obliques, rectus abdominis, erector spinae
Reps: 8–12 on each side
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with your feet about shoulder-width apart and hold a dumbbell with both hands. Hinge forward at your hips and bend your knees to sit back into a slight squat. Rotate your torso to the right and extend your arms to hold the dumbbell on the outside of your right knee.

Movement: Straighten your legs to stand up as you rotate your torso to the left and raise the weight diagonally across your body and up to the left, above your shoulder, while keeping your arms extended. In a chopping motion, slowly bring the dumbbell down and across your body toward the outside of your right knee. This is one rep. Finish all reps, then repeat on the other side. This completes one set.

Tips and techniques:

  • Keep your spine neutral and your shoulders down and back
  • Reach only as far as is comfortable.
  • Keep your knees no farther forward than your toes when you squat.

Make it easier: Do the exercise without a dumbbell.

Make it harder: Use a heavier dumbbell.

Bent-over row



Muscles worked: Latissimus dorsi, deltoids, biceps
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with a weight in your left hand and a bench or sturdy chair on your right side. Place your right hand and knee on the bench or chair seat. Let your left arm hang directly under your left shoulder, fully extended toward the floor. Your spine should be neutral, and your shoulders and hips squared.

Movement: Squeeze your shoulder blades together, then bend your elbow to slowly lift the weight toward your ribs. Return to the starting position. Finish all reps, then repeat with the opposite arm. This completes one set.

Tips and techniques:

  • Keep your shoulders squared throughout.
  • Keep your elbow close to your side as you lift the weight.
  • Keep your head in line with your spine.

Make it easier: Use a lighter weight.

Make it harder: Use a heavier weight.




Muscles worked: Deltoids, latissimus dorsi, erector spinae
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Lie face down on the floor with your arms extended, palms down, and legs extended.

Movement: Simultaneously lift your arms, head, chest, and legs off the floor as high as is comfortable. Hold. Return to the starting position.

Tips and techniques:

  • Tighten your buttocks before lifting.
  • Don’t look up.
  • Keep your shoulders down, away from your ears.

Make it easier: Lift your right arm and left leg while keeping the opposite arm and leg on the floor. Switch sides with each rep.

Make it harder: Hold in the “up” position for three to five seconds before lowering.

Can vitamin D supplements prevent autoimmune disease?

Close up of soft gel vitamin D capsules on a yellow background

You don’t have to look far to find claims that taking vitamin D supplements is great for your health. It’s supposed to be good for everything from preventing cancer and dementia to avoiding infections and heart disease.

Unfortunately, many supposed benefits of vitamin D supplements remain unproven. Yet, millions of people take vitamin D regularly, thinking it will help prevent a wide range of illnesses, including certain autoimmune conditions. But does it? A new randomized, controlled study published in TheBMJ looks closely at that question.

Why would vitamin D prevent autoimmune disease?

Although the cause of most autoimmune disease is largely unknown, the leading theory is that the regulation of the body’s immune system goes awry. The immune system normally defends the body from invaders such as infections, and helps repair damaged tissues. When an autoimmune condition develops, the immune system attacks its host. For example, with rheumatoid arthritis, immune cells attack joints, lungs, and other parts of the body.

Research has shown that vitamin D can interact with immune cells, affect genes that regulate inflammation, and alter the response of the immune system. So it makes sense to investigate whether supplemental vitamin D is an effective way to treat or prevent autoimmune disease.

The BMJ study drew on data gathered during a large trial published several years ago. More than 25,000 older adults were randomly assigned to take

  • 2,000 IU of vitamin D or an identical placebo (inactive pill) daily. (This is higher than the recommended daily amount for adults, but lower than the upper limit of 4,000 IU.)
  • 1,000 mg of omega-3 oil or an identical placebo daily.

After an average of five years, new diagnoses of autoimmune disease among study participants were tallied.

What did the new study find?

The answer may depend on where you heard or read about the BMJ study. It’s true that the researchers found that adults taking vitamin D supplements had a lower risk of developing autoimmune disease. But here’s what some of the more enthusiastic news headlines said:

  • Vitamin D supplements really do reduce risk of autoimmune disease (New Scientist)
  • Taking Vitamin D Daily Can Help Prevent This Disease, New Study Says (Eat This, Not That!)
  • Taking vitamin D and omega-3 fish oil supplements every day cuts your risk of developing arthritis by 22%, study suggests (Daily Mail)

Sounds great, right? But is it true?

What does a closer look at the study tell us?

The researchers reported that

  • 123 people taking vitamin D developed autoimmune disease, compared with 155 people in the placebo group. This represents a 22% reduction. That sounds like a lot, but the actual decrease in risk for developing an autoimmune disease fell from about 12 people in 1,000 to 9.5 people in 1,000.
  • Rheumatoid arthritis, polymyalgia rheumatica, and psoriasis were the most common conditions. No single autoimmune disease was reliably prevented by vitamin D supplementation. Only when the numbers of all the autoimmune diseases were combined did researchers see a benefit.
  • The benefit of vitamin D was more obvious when only the final three years of the study were analyzed. This suggests that it takes a while to benefit from a daily supplement.
  • Those assigned to receive omega-3 fatty acids did not have a lower risk for confirmed autoimmune disease.
  • Side effects were minor and similar in those taking supplements and those taking placebo.

This randomized study is among the best to explore the impact of vitamin D supplementation on the risk of developing autoimmune disease. Yet the study relied on self-reported cases, later confirmed by medical record review. So it’s possible that some cases of autoimmune disease were overlooked.

In addition, the study only included older adults (average age 67). This is important because some of the most common autoimmune diseases, such as lupus and rheumatoid arthritis, typically begin in early adulthood. The results might have been different if the study had included younger participants.

Should we all be taking vitamin D supplements?

Based on this study, I’d say no. For one thing, these findings need to be confirmed by other independent researchers. And despite overly enthusiastic headlines, actual risk reduction was just 2.5 cases out of 1,000. Hundreds of people would need to take vitamin D daily for years to prevent a single case of autoimmune disease. Vitamin D can interact with other medicines, and taking high amounts of vitamin D can be harmful.

The bottom line

Is vitamin D a safe, all-natural wonder drug that can prevent or treat a litany of diseases? Based on current research that’s not clear yet, though I think it’s best to keep an open mind. We may find vitamin D does little for the average person but is highly beneficial for others; the trick is figuring out who is most likely to benefit. For example, perhaps supplemental vitamin D will be especially helpful for people who have a strong family history of certain autoimmune diseases.

Right now, we have the latest chapter in the story of vitamin D. Future research may reveal that a different dose or formulation of vitamin D might be particularly beneficial. Perhaps most importantly, this study and others to come could provide a better understanding of the role of vitamin D in the development of autoimmune diseases.

Follow me on Twitter @RobShmerling