Robotic surgery (robotic prostatectomy) is a laparoscopic approach to the treatment of prostate cancer using the da Vinci robot to assist. This device provides three-dimensional vision, magnification and an articulating robotic wrist. The robot recreates the actions performed by the surgeon at the console in a more precise manner.
Number of surgeries performed, training and experience are important in outcomes for patients with prostate cancer. Dr. Anup Ramani is fellowship-trained in oncology (additional training after a residency) and Focused specifically on this area. This approach permits some of the best outcomes with regard to minimizing side-effects and maximizing cancer control.
Yes. The prostate is removed entirely, sparing the cavernous nerves and urethral sphincter, in the same fashion as open surgery.
Yes, this depends on the stage, grade and PSA of your cancer.
The actual procedure normally takes 1 to 1.5 hours, although unusual circumstances can increase the time required.
This less-invasive surgical procedure utilizes a state-of-the-art surgical system that helps your surgeon see vital anatomical structures more clearly and to perform a more precise surgical procedure. For most patients, robotic prostatectomy offers numerous potential benefits over open prostatectomy, including:
- Shorter hospital stay
- Less pain and pain medication
- Less blood loss and transfusions
- No blood donation necessary from the patient
- Less scarring
- Shorter catherization
- Quicker return to normal activities
One benefit of this procedure is the minimal loss of blood, so typically you will not have to donate your own blood.
How long will I have to stay in the hospital after surgery, and when can I resume normal activities?
Most robotic prostatectomy patients are able to go home within 4 Days after surgery. Most patients are able to resume normal activities about 14 to 21 days after surgery.
Will I have a urinary catheter after the surgery, and will I have normal urinary control after this procedure?
Yes. A urinary catheter is required to ensure adequate bladder drainage and facilitate healing of the area. Most patients experience some incontinence immediately following catheter removal, but their urinary control generally returns with time.
Not immediately, although erectile function returns for most patients within nine to 12 months. Some patients are able to resume sexual intercourse within a shorter time. All patients who have a radical prostatectomy, regardless of the type of surgery used, will be sterile.
Some of the major benefits experienced by surgeons using the da Vinci Surgical System over traditional approaches have been greater surgical precision, increased range of motion, improved dexterity, enhanced visualization and improved access. Benefits experienced by patients may include a shorter hospital stay, less pain, less risk of infection, less blood loss, fewer transfusions, less scarring, faster recovery and a quicker return to normal daily activities.
Most men with localized prostate cancer are candidates for Robotic prostatectomy surgery. The ideal candidate for robotic prostatectomy is a younger man in good physical health with little co-morbidity, a small prostate, and a lower-grade, low-volume tumor. Generally, men with Gleason scores of 8, 9, or 10, and/or advanced stage T3-T4 disease would not be considered due to risk of cancer extension beyond the prostate.
Dr. Ramani did his first robotic surgery in 2004, so it is not as new as one thinks.
Will the robot make the surgeon unnecessary? Does Dr. Ramani operate or does the robot perform surgery?
On the contrary, the da Vinci System enables Dr. Ramani to be more precise, advancing his technique and enhancing his capability in performing complex minimally invasive surgery. The robot replicates the surgeon’s movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon’s input.
In the hands of highly experienced surgeons like Dr. Ramani, the outcomes of robotic and laparoscopic surgery are exactly the same. The incisions, blood loss, hospital stay and cancer clearance is comparable. However, if your surgeon is not very experienced with minimally invasive surgery, it is better to stick with open or whatever method your surgeon is most comfortable doing. Forcing your surgeon to perform newer surgeries he/she is not used to, can result in severe complications.
The prostate is a gland found only in men about the size of a large walnut and is just below the bladder. The prostate's main function is to make fluid for semen, a white substance that carries sperm. When urine passes, it flows through a tube (urethra) and out through the penis. The urethra has to pass through the prostate before reaching the penis.
Prostate cancer is a malignant tumour in the prostate. There are several stages of prostate cancer. Most prostate cancers develop slowly and do not cause any symptoms. Fast-growing prostate cancer is less common. The risk of getting prostate cancer increases with age.
Worldwide, prostate cancer incidence and mortality are expected to grow to 1.7 million by the year 2030.
Scientists don't know exactly what causes prostate cancer. They cannot explain why one man gets prostate cancer and another does not. However, they have been able to identify some risk factors that are associated with the disease. A risk factor is anything that increases the chances of getting a disease.
Older age, African American race, and a family history of the disease can all increase the likelihood of a man being diagnosed with the disease. As men increase in age, their risk of developing prostate cancer increases. About 60% of all prostate cancers are diagnosed in men over the age of 65. There is some evidence that a diet high in animal fat may increase the risk of prostate cancer and a diet high in fruits and vegetables may decrease the risk.
Prostate cancer is generally asymptomatic, which means that there are no clear symptoms to indicate it. If prostate cancer does cause symptoms it is usually a sign that the disease has advanced. The symptoms may include:
- Urinary symptoms such as urinary frequency or a weak stream of urine
- Blood in the urine
- Erection problems
- Urinary incontinence
- Loss of bowel control
- Pain in the hips, back, chest, or legs
- Weak legs
Yes. Any of the symptoms caused by prostate cancer may also be due to enlargement of the prostate [Benign prostatic hyperplasia (BPH)] or infection, which is not cancer. If any of these symptoms are present, visiting doctor or a urologist to find out the cause is important.. A urologist is a doctor who specializes in treating diseases of the genitourinary system.
Screening for prostate cancer can be performed in a physician’s office using two tests: the PSA (prostate-specific antigen) blood test and the digital rectal exam (DRE).
The PSA test is a blood test that is commonly used to detect possible prostate cancer. Elevated PSA levels may indicate the presence of prostate cancer, but can also be caused by other common non-cancer related conditions such as an enlarged prostate (benign prostatic hyperplasia or BPH) or inflammation of the prostate gland (also known as prostatitis) due to an infection or other cause.
The doctor may order other exams, including ultrasound, MRI, or CT scans, to learn more about the cause of the symptoms. But to confirm the presence of cancer, doctors must perform a biopsy where needles are used to remove small tissue samples from the prostate and then samples are analysed under a microscope. Doctors describe a tumor as low, medium, or high-grade cancer, based on the way it appears under the microscope.
There are a number of ways to treat prostate cancer, and the doctor will develop a treatment to fit each man's needs. The choice of treatment mostly depends on the stage of the disease and the grade of the tumor. But doctors also consider a man's age, general health, and his feelings about the treatments and their possible side effects. Treatment for prostate cancer may involve watchful waiting, surgery, radiation therapy, or hormonal therapy. Some men receive a combination of therapies. A cure is possible for men whose prostate cancer is diagnosed early.
With watchful waiting, a man's condition is closely monitored, regular check-ups, but treatment does not begin until symptoms appear or change. The doctor may suggest watchful waiting for some men who have prostate cancer that is found at an early stage and appears to be growing slowly. Also, it may be advised for older men or men with other serious medical problems.
Surgery is a common treatment for early stage prostate cancer. It is used to remove the cancer. The surgeon may remove the entire prostate which is a type of surgery called radical prostatectomy or, in some cases, remove only part of it.
Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Doctors may recommend it instead of surgery or after surgery to destroy any cancer cells that may remain in the area. In advanced stages, the doctor may recommend it to relieve pain or other symptoms.
Hormonal therapy deprives cancer cells of the male hormones they need to grow and survive. This treatment is often used for prostate cancer that has spread to other parts of the body. Sometimes doctors use hormonal therapy to try to keep the cancer from coming back after surgery or radiation treatment.
Surgery, radiation therapy, and hormonal therapy all have the potential to disrupt sexual desire or performance for a short while or permanently. Several options are available to help manage sexual problems related to prostate cancer treatment.
Regardless of the type of treatment received, patient will be closely monitored to see how well the treatment is working. Monitoring may include:
- a PSA blood test, usually every 3 months to 1 year
- bone scan and/or CT scan to see if the cancer has spread
- a complete blood count to monitor for signs and symptoms of anemia
- looking for signs or symptoms that the disease might be progressing, such as fatigue, increased pain, or decreased bowel and bladder function.
Yes. Today, more men are surviving prostate cancer than ever before. In fact, the number of deaths from prostate cancer has been declining since the early 1990s. If found early, the disease can very likely be cured.