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Prostate Cancer
Prostate cancer is the leading type of non-skin cancer in American men, with 1 of every 6 men diagnosed sometime in his life. And though more than 40,000 deaths related to prostate cancer occur each year, greater public awareness and early detection are causing mortality rates to decline.
 The prostate is a walnut-sized gland in the male reproductive system. Located just below the bladder and in front of the rectum, it surrounds the urethra –- the tube that empties urine from the bladder –- and produces fluid that makes up part of the semen.
When malignant cells form in the tissues of the prostate, it is considered prostate cancer. However, the cancer can spread outside the prostate as it grows. It typically spreads to the lymph nodes and bones surrounding the prostate.
Though the specific cause of prostate cancer currently is not known, heredity, diet and other environmental factors likely play a role. And prostate cancer has no early warning signs associated with it. If the prostate grows large enough, some urinary-related symptoms -– including frequent urination and urinary leakage -– could arise. However, since they usually are indicative of a non-cancerous enlarged prostate, having these symptoms does not directly indicate that prostate cancer is present.
Treatment for prostate cancer
When diagnosed early, prostate cancer is a highly curable disease for which most men are treated early and go on to live active and productive lives.
There are several types of treatment options available for those diagnosed early with prostate cancer, including watchful waiting, radiation therapy, brachytherapy (radioactive seeds), cryosurgery (freezing the prostate), and surgical removal of the prostate (radical prostatectomy). But which treatment option is best for a patient is based on a number of factors including the stage of the cancer, the patient’s Gleason score and the patient’s age and general health.
For the majority of patients diagnosed with early-stage prostate cancer, surgical removal of the prostate or radiation therapy are the primary options. In cases when the cancer also is localized to the prostate, it is highly curable through radical prostatectomy surgery.
Prostatectomy includes removing the prostate gland completely to cure the cancer and reconstructing the urinary system so that normal bladder control is achieved and sexual function can be maintained. The primary goal of the procedure is removal of the cancer. A secondary goal is to preserve urinary function and –- when applicable –- erectile function.
Open prostatectomy traditionally involves an 8- to 10-inch incision to access the prostate. The incision extends from the belly button down to the pubic bone, just above the penis. The muscles then are separated to gain access to the prostate gland and the anterior surface of the bladder. This approach often results in substantial blood loss and lengthy, uncomfortable recovery.
Some of these drawbacks are addressed with the laparoscopic radical prostatectomy. It uses smaller incisions and usually results in a shorter recovery period.
Despite these advantages, conventional laparoscopy relies on rigid, counterintuitive instruments and video quality that can be challenging for the surgeon. Moreover, neither laparoscopy nor open surgery can provide adequate maneuverability around the delicate nerves surrounding the prostate that control sexual function.
Robotic-assisted prostatectomy: a less invasive and more effective option
 Robotic-assisted surgery is a less invasive and potentially more effective alternative to laparoscopic and open radical prostatectomy.
When performed robotically with the da Vinci Surgical System, the prostatectomy is done with unparalleled precision and control through a few small incisions along the abdomen.
Potential patient benefits of the robotic prostatectomy include:
- Less pain
- Less risk of wound infection
- Less blood loss
- Less scarring
- Faster recovery
- Quicker return to normal activities
The technique also has been shown to offer improved cancer control and a faster return to erectile function and continence. (Source: Intuitive Surgical)
Outcome |
Robotic prostatectomy |
Laparoscopic prostatectomy |
Open prostatectomy |
Cancer control
T2 margin status |
2.5
|
7.7
|
5.9
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Complications
Length of hospital stay
Major
Minor |
1.2 days
1.7%
3.7%
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2.5 days
3.7%
14.6%
|
3 days
6.7%
12.6%
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Urinary function
3 month
6 month
12 month |
92.9%
94.9%
97.4%
|
62%
77%
83%
|
54%
80%
93%
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Sexual function
12 month |
86%
|
76%
|
71%
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As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. While robotic-assisted prostatectomy is considered safe and effective, it may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.
Illustrations courtesy of Intuitive Surgical, Inc.
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