These advanced surgical techniques can not only extract the cancer, they also can help preserve quality of life after prostate cancer treatment
Prostate cancer is the second-most common cancer diagnosis among men (after skin cancer), affecting 1 out of every 9 men in his lifetime. As is the case with many cancers, it is more commonly found in older men. Fortunately, prostate cancer is also very treatable, particularly if it is found early. When localized to the prostate and surrounding tissues, we can often address it surgically by removing the prostate in a procedure called a prostatectomy.
One important caveat: surgery is not appropriate for every prostate cancer diagnosis, and sometimes surgery is combined with other treatment methods such as radiation or chemotherapy to combat the tumor. Some patients may decide with their urologist to actively monitor the cancer (this is called “active surveillance”) instead of treating it, because prostate cancer can frequently be slow to develop and cause few symptoms or none in its early stages.
That being said, if surgery will play any kind of role in a patient’s prostate cancer treatment plan, he should feel confident that he is entrusting his care to a knowledgeable, experienced urologic oncology surgeon who’s well-versed in the latest in prostatectomy technologies.
At cCARE, we proudly offer the latest in surgical technology for all aspects of urologic oncology. But when it comes to prostatectomies, it wasn’t all that long ago that patients had very few options.
The way we used to perform a prostatectomy
When I completed training in 2003, the majority of prostate removals were performed using what’s called open technique. As the name implies, this meant that we made a large, open incision in order to access and remove the prostate and surrounding tissues. There was typically significant collateral damage as a result of the surgery.
Open prostatectomy typically is associated with higher rates of blood loss compared with the robotic approach, so much so that some patients require blood transfusions. There can also be a significant amount of post-operative pain as well as extended hospital stays. Perhaps most importantly, open prostatectomies can lead to long-term impotence (erectile dysfunction) and incontinence (urinary leakage), potentially decreasing a man’s quality of life permanently.
Following a broader surgical trend across multiple medical specialties toward minimally-invasive techniques, many surgeons have moved to performing laparoscopic radical prostatectomies (LRP), which use small portal holes in the abdomen through which a camera and surgical instruments are inserted. LRP decreases recovery time and lowers the overall risk of surgical complications, including impotence and incontinence. Performed in the hands of a skilled surgeon, LRP has been shown to be equal in effectiveness to traditional open prostatectomy in treating prostate cancer.
Harnessing robotic technology for the best possible outcome
It is important to understand that the persistent complications of prostate cancer surgery are often the result of nerve damage in the region. There are nerves surrounding the prostate that profoundly affect a man’s ability to get and maintain an erection. Voluntary control of the bladder (urinary continence) can also be affected and is usually the result of removal of the intrinsic urinary sphincter located at the opening of the bladder. Therefore, in both open and LRP surgeries, the risk of collateral nerve damage is heavily dependent on the exacting dexterity of the surgeon.
Enter the da Vinci robot.
Prostatectomy using the da Vinci robotic system is emerging as a highly effective method for treating prostate cancer. The surgical robot gives us unparalleled control and access, allowing us to sidestep or minimize some of the devastating side effects caused by traditional surgical methods.
Aided by a high-definition camera and finely-tuned robotic surgical instruments, this special machine allows the surgeon to make highly controlled movements with a range of motion that is simply not possible with open or laparoscopic techniques. As the surgeon sits at the control station, the robotic system interprets the movements of his or her hands and scales them down, allowing for a degree of precision and subtle movement that the human hand is simply not capable of making. When we’re dealing with an area as sensitive as the prostate and the nerves and tissues surrounding it, this precision can literally be what preserves a man’s ability to have a healthy sex life and maintain urinary continence following the operation.
This technology is greatly improving outcomes for men requiring a prostatectomy for cancer treatment. While a robotic prostatectomy may not be the appropriate option for every prostate cancer patient, it is important to me that men facing this disease are aware of this technology and the implications it has on the long-term quality of life for cancer survivors.
Following a prostate cancer diagnosis, a man should not hesitate to ask his urologic oncologist if he has experience performing robotic prostatectomies. He shouldn’t be afraid of seeking a second (or third) opinion when it comes to developing a plan for treatment.
I am currently serving as the chairman of the Robotic Surgery Program at Palomar Medical Center and maintain an active membership in the Society of Robotic Surgery. I’m also a proctor at Intuitive Surgical, where I teach urologists nation-wide how to perform surgery using these robotic technologies.
I am thrilled to see more and more physicians adopt this exciting new surgical method that is allowing men to live fuller lives on the other side of prostate cancer surgery.