Robot Assisted Surgery for Prostate Cancer

More than 200,000 men will be diagnosed with prostate cancer in 2010. Those of them that need surgery will find a remarkable new tool in their surgeon’s hands.

Health statistics tell us that about 1 of every 6 men will be diagnosed with prostate cancer during his lifetime. In the years since the prostate-specific antigen (PSA) test became widespread, most cases of prostate cancer are discovered in the early, localized stages. This is a good thing. It can also be a confusing thing for patients.

Not every case of prostate cancer will spread and become life threatening. Unfortunately, there is not yet a dependable way to determine which cancer will remain safely slow-growing, and which will dangerously pick up velocity. It’s important to thoroughly discuss the benefits and risks with your physician before making a treatment decision.

“Usually, an elevated PSA is what brings a patient in to see us,” says Premier Medical’s Dr. Naeem Rahman. “We look at what sort of change has occurred in the patient’s PSA history, consider any symptoms, and perform a digital rectal exam.

Since there are a number of factors that can give a temporarily elevated PSA reading, we always double check and give a fresh test.”

“If the PSA numbers suggest it,” Dr. Rahman says, “we would advocate a prostate biopsy. If the biopsy is negative, we reassure the patient and advocate another PSA or exam in about six months. If the biopsy is positive, the response is open-ended. We consider the patient’s age, comorbidities, and the aggressiveness of the cancer before making a treatment recommendation.

“In the PSA era there’s a downward movement in the stage at which prostate cancer is first diagnosed,” says Dr. Rahman. “It’s considered a slow-growing cancer, and treatment decisions need to take that into account. But I would emphasize that we still see prostate cancers that are very aggressive and life threatening.” The promise of robot-assisted surgery Radical prostatectomy, removal of the prostate, is used most often if the cancer is not thought to have spread outside the gland. An open surgery radical prostatectomy was first performed about 1901 and, with many refinements, was the reigning technique for a hundred years.

The first robot-assisted laparoscopic radical prostatectomy (RALRP), using the da Vinci(R) Surgical System—the system we use at Premier Medical— was performed in early 2000. Urologic surgeons have so enthusiastically adopted the procedure, and patients seem so satisfied with it, that RALRP is now the most common approach to removing the prostate. Just 10 years after its introduction, according to the National Cancer Institute, 70% of radical prostatectomies are performed with robotic assistance. Surgeons have been impressed by robot-assisted surgery’s ability to provide their patients with the reduced trauma of a minimally invasive procedure while overcoming the limitations of standard laparoscopy.

When compared to open surgery, a patient undergoing RALRP can expect to experience:

  • Less pain following the operation
  • Less risk of infection
  • Less need for anesthesia
  • Less blood loss
  • A shorter hospital stay
  • Faster and more complete recovery
  • A quicker return to normal daily activities.

The goal of a radical prostatectomy is to remove the cancerous prostate and ensure that none of the cancer is left behind. Additionally, in most cases, the surgeon aims to spare the nerves necessary for achieving erections and to reattach the bladder to the urethra to maintain urinary continence. Numerous studies suggest that these goals are better met by RALRP than by standard laparoscopy and that results are at least as good as those obtained by open surgery. The many surgeons who now recommend robot-assisted radical prostatectomy over other methods find that the technology gives them enhanced capabilities, including more surgical precision and dexterity.How the da Vinci Surgery System works. The robotic system isn’t “programmed” to perform operations and it doesn’t make any decisions on its own. Your surgeon is the one making every surgical maneuver and decision. The robotic system just assists, translating the surgeon’s hand, wrist and finger movements on the controls into the precise movements of miniaturized instruments. In a da Vinci robot-assisted surgery, a series of small, dime-size incisions are used to introduce miniaturized instruments and a high-definition 3D camera into the patient’s body. The camera delivers crystal-clear images enlarged as much as 12 times.

The surgeon sits at a console a few feet away from the patient, operating the surgical instruments with hand and foot controls. The surgeon can change the scale of motion: if the surgeon moves his hand two inches, for example, the robot can be set so that it will only move one inch. This provides exceptional control for procedures needing extremely fine movements. The surgical robot also removes surgical tremor, so that if the surgeon’s hands shake slightly, those extremely small movements are not translated into the instruments and the maneuvers are rock-steady.

Since the da Vinci System’s patient cart does the work of holding and re-positioning the instruments and camera — and because your surgeon operates while seated —surgeons can experience less fatigue when performing robotassisted surgery. This translates into greater focus on the patient and the procedure. The surgeon’s experience, commitment, and skill remains of critical importance. At Premier Medical, Dr. Rahman’s expertise ensures our patients get the most from the da Vinci system.