Robotic Surgery for Prostate Cancer

In Singapore, prostate cancer is the second most commonly diagnosed cancer in men and the fifth leading cause of death worldwide. As men move into their 50’s, their risk of prostate cancer increases. Thankfully, prostate cancer is treatable, and with early detection, one can make a full recovery.

The prostate gland is a walnut-sized gland located below the urinary bladder, surrounding the urethra, and is responsible for the production of prostatic fluid that nourishes the sperm. Its development is controlled by the male hormone, testosterone. Prostate cancer is the result of the uncontrolled proliferation of abnormal cells, resulting in a malignant tumour.

How is Prostate Cancer typically treated?

Treatment for prostate cancer largely depends on the risk classification and stage of the cancer. Prostate cancer is curable if detected and treated early. An early diagnosis translates to earlier treatment and better chances of making a full recovery.

Studies have shown that there is a 95-99% 5-year survival rate in men who were diagnosed with low and intermediate prostate cancer while it is localised. This percentage drops to 31% when the prostate cancer has spread to other parts of the body.

Active surveillance

For low-risk, localised prostate cancer, conservative measures may be recommended, and this involves closely monitoring the progress of the cancer. This is done through regular blood tests, digital rectal exams and prostate biopsies to monitor the cancer’s progression. If it progresses, treatment will be given promptly.

Treatment for localised prostate cancers

Localised prostate cancer refers to cancer that has not spread to other tissues or organs.

• Radical Prostatectomy — This surgical procedure involves removing the entire prostate and seminal vesicles. This can be done through open, laparoscopic or robot-assisted surgery.
  
  With minimally invasive procedures such as laparoscopic or robot-assisted surgery comes smaller incisions. This, in turn, leads to a faster recovery, fewer complications and earlier discharge. Generally, patients can return to their normal activities after 2 to 4 weeks.
  
  
• Radiation Therapy — Radiation therapy involves the use of high-powered energy rays or particles. Short-term hormonal treatment may be incorporated as well. This may consist of about 8 to 38 sessions, depending on the type of radiation schedule.
  
  Radiation therapy may be recommended for older patients with multiple medical problems who should avoid general anaesthesia.

Treatment for metastatic prostate cancer

Metastatic prostate cancer refers to cancer that has spread to other tissues or organs. Treatment options include:

• Androgen Deprivation Therapy (ADT) — ADT helps suppress the testosterone levels in the body and slow down the progression of prostate cancer. ADT can be administered via regular injections with medication or surgical removal of both testes. ADT is often combined with novel hormonal agents.
  
  
• Chemotherapy — Chemotherapy is a viable option when prostate cancer has spread outside the prostate gland, and/or ADT is deemed ineffective. Recent research has shown that chemotherapy combined with ADT may be helpful in managing selected high-risk prostate cancer, and treatment is given every 3 weeks.
  
  
• Symptomatic Treatment — As its name suggests, symptomatic treatment involves the management of symptoms depending on where the cancer has spread. This includes analgesia or radiotherapy to relieve symptoms or surgeries for palliative care.

What is Robotic Surgery?