da Vinci® Prostatectomy - Prostate Cancer Treatment

The prostate is a truly fascinating organ nestled snugly beneath the bladder, wrapping around the male urethra which carries urine through the penis for elimination. This walnut-shaped gland sits at the strategic junction of the male urinary and reproductive tracts and is often overlook until it causes trouble. Without the prostate gland men will invariably be infertile as it is responsible for producing seminal fluids, which nourishes sperm during their arduous journey.

However, as life expectancy worldwide lengthens, the prostate has gained an unflattering sobriquet as the ‘Aging Man’s Bane’ ¹ as sooner or later, health issues arising from of the prostate afflicts every man who lives long enough which may range from bothersome prostate enlargement to the more sinister prostate cancer.   

What is Prostate Cancer and what causes them?

Prostate cancer occurs when cells within the gland begin to grow uncontrollably. This unwelcome invader is usually silent and often shows no symptoms at the early stages. However, as it progresses, the symptoms begin to unfurl like an unpleasant surprise which may present as unpleasant urination, presence of blood in the urine or semen, or pain in the lower back, hip or thighs in late stages where it has spread to the bones.

No one is entirely sure why it happens but there are some strong suspects that can increase your risk of developing prostate cancer. Age is one of the prime culprits as the risk of prostate cancer increases significantly as men age and can be as high as 60% as men enters their golden years.

Genetics also play a starring role; if your father or brother had prostate cancer, your chances of developing it are more than doubled. Prostate cancer has also been found to be closely linked to breast and cervical cancers as they share a common genetic defect in the BRCA genes which can be passed on in families.

Unhealthy lifestyle habits such as smoking and sedentary lifestyle might also influence risk hence it is important for men with such predilections to quit while ahead!

How can we detect a cancer with no symptoms?

Detecting prostate cancer in early stages when there are no symptoms relies on proactive screening methods and vigilance. We usually recommend men over 50 years old to undergo regular prostate screenings unless they are at a higher risk where screenings may begin earlier at the age of 45 for those with family history or cancers or at 40 for those harbouring genetic mutations.

Prostate screening will usually involve a rectal examination to detect abnormalities in the prostate gland such as lumps or irregular hard areas and a blood test for Prostate-Specific Antigen (PSA). For those at higher risk of concerning PSA levels, a Magnetic Resonance Imaging (MRI) may be performed to provide detailed images of the prostate, helping to identify suspicious areas that might require a biopsy. The definitive way to diagnose prostate cancer is by obtaining small samples of prostate tissue for examination and detection of cancer cells. While this endeavour used to be a like a little treasure hunt, advancements in biopsy technique including robotic guidance has enabled urologists to target specific areas of concern with fewer samples needed, lowering the risks to patients.

How do we treat prostate cancer?

The good news is prostate cancer us highly treatable especially when caught early. The treatment journey will start with a CT scan and Bone Scan or a PET scan to accurately stage the cancer and tailor each patient’s treatment. Here are the main options we usually offer to early prostate cancers:

1. Active surveillance: Those with very slow-growing cancer may not require immediate treatment and your urologist might recommend keeping an eye on it to make sure that it does not cause any trouble. Known as the ‘snail of cancers’, we always try to balance the benefits and potential side effects of any treatment to preserve patients’ quality of life.
2. Surgery: For misbehaving cancers which is expected to cause problems in the future, the commonest surgical procedure for prostate cancer is a radical prostatectomy, where the entire prostate gland including the seminal vesicles are removed. While it may sound daunting, modern techniques and the introduction of robotic surgery have significantly improved outcomes and recovery times.

Radiation Therapy or Focal Therapy: These treatments use high-energy rays or ultrasound to target and kill cancer cells and can be considered in place of surgery, but these will usually require the addition of hormone therapy to ensure sufficient elimination of cancer cells.

What is Da Vinci Radical Prostatectomy and why should I prefer it?

The Da Vinci robotic-assisted radical prostatectomy represents a revolutionary advancement in prostate cancer surgery. Its benefits in terms of precision, reduced blood loss, faster recovery, minimal scarring, enhanced surgeon dexterity, and improved functional outcomes make it a preferred choice for many patients and surgeons.

In the past two decades, the adoption of robotic-assisted surgery has increased significantly, and it now accounts for 85-90% of radical prostatectomies performed in the United States in recent years due to the significant benefits it offers over conventional methods, namely:

1. Precision and Accuracy
   
   a. The Da Vinci system allows for unparalleled precision in surgical movements with enhanced magnification and 3D visualisation in a highly confined space which can be as small as a tangerine in an adult man. The enhanced vision and dexterity is critical in ensuring the surgeon is able to see the diseased tissue and remove them completely but also enables finely tuned navigation around delicate structures such as nerves and blood vessels, minimising damage to surrounding tissues reducing blood loss.
   
   
2. Less Pain and Faster Recovery
   
   a. Robotic prostatectomy is a minimally invasive technique performed through key-holes thus patients generally experience less post-operative pain, shorter hospital stays and faster return to normal activities compared to those who undergo open surgery. The smaller incisions are also lead to minimal scarring, both externally and internally which is not only important cosmetically but reduces the risk of infections and complications associated with larger surgical wounds.
   
   
3. Improved Outcomes for Urinary and Sexual Function
   
   a. Preserving urinary and sexual function is a significant concern for many men undergoing prostate surgery. The precision of the Da Vinci system aids in nerve-sparing techniques, which are crucial for maintaining these functions post-surgery. Studies have shown that patients undergoing robotic-assisted prostatectomy often report better outcomes in terms of urinary continence and erectile function.

What can be expected postoperatively after Da Vinci Radical Prostatectomy?

Patients undergoing Da Vinci Prostatectomy typically recover quickly. Most patients stay in the hospital for 1-2 days after the surgery and are encouraged to start moving and walking as soon as possible to prevent blood clots and promote circulation. Pain is typically managed with intravenous or oral pain medications but are usually minimal.

A urinary catheter is usually inserted during surgery to help drain the urine while the bladder and urethra heals and is left in place for a week. Catheter care will be taught to patients to ensure that they are able to manage catheter care at home confidently including keeping it clean and emptying when full.

After a week the catheter is removed and some urine leakage when coughing or straining is expected and should improve gradually over the next weeks to months and normal activities can be resumed after 4 to 6 weeks.

Long term follow up is vital and will include monitoring of the cancer recurring through PSA testing every few months and ensuring patients regain urinary control and erectile function through tailored rehabilitation programs.

In summary, prostate cancer may be a formidable foe, but with early detection and a range of effective treatments, many men go on to live long, healthy lives. Remember, regular check-ups and an open dialogue with your urologist are key. And if you find yourself waking up for yet another nighttime bathroom trip, it might just be your prostate’s way of saying, “Hey, don’t forget about me!

Reference:

1. Jane E Brody. Prostate, bane of aging men, is yielding to new treatments. The New York Times. 1985, April 9.

Dr Aaron Goh Yue Keng,
Urologist Consultant
Gleneagles Hospital Penang

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