With all of the different options for the treatment of prostate cancer, patients often ask me why I recommend robotic prostatectomy. I'll share the reasons with you now.
1. The complete removal of the cancer. Surgery is the only way to completely remove the cancer. Occasionally a tiny portion of tumor is left behind (a positive margin), but we know when this happens and can tailor our management accordingly. Additionally, we remove the lymph nodes, which are involved with cancer in a small proportion of patients.
2. Better knowledge of the cancer. The only information we have of the prostate cancer prior to treatment is from the prostate biopsy and CT or bone scans, which are known to be inaccurate. Often, the prostate cancer is different than the biopsy, which would have led to either too much or too little treatment if that were the only piece of information we had.
3. Different side effects. Following radiation, it is not uncommon for men to develop diarrhea and bleeding from the rectum, which is because the rectum also receives radiation. Men also can feel the need to urinate all the time, and sometimes cannot urinate at all, requiring a catheter in the bladder for a long period of time. The risk of developing problems with erections after radiation is about the same as after surgery.
4. Easier post-operative cancer monitoring. The PSA test is a very sensitive marker of prostate cancer. After surgery, it should drop to zero. If a recurrence occurs, the PSA will start to go up, and we will know about it very quickly. With other treatments, the PSA does not go to zero, and it's difficult to know if increases in PSA are due to recurrences or not. This can lead to quicker treatment of recurrences, improving the chance of cure.
5. Easier treatment of recurrences. In the unfortunate event that the prostate cancer comes back after surgery, it is much easier to treat than after other treatments. For example, it is easy to give radiation to the prostate bed after surgery, but surgery after radiation is very difficult. Such surgery has high rates of side effects and complications, especially incontinence.
6. Risk of second cancers. Although radiation is used to treat cancer, it is also known to cause cancer in normal tissue. Studies show higher rates of bladder, rectal and lung cancer in men who received radiation for their prostate cancer than in those who had surgery.
7. Robotic prostatectomy: I use a 3 dimensional camera that magnifies the field of surgery, working in a bloodless field. As a result, I don't need to use any tactile feedback. If I can see it, I don't need to touch it. In open surgery touch factor was important since there was a lot of blood and working in blind areas of the surgery mandated tactile feedback but that is not necessary anymore.
For these reasons and others, it is my opinion that a radical prostatectomy in the hands of an experienced surgeon is the best option for a man newly diagnosed with prostate cancer.
David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site, Robotic Oncology, has been translated into six different languages and is one of the most popular urology sites on the Internet.
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