For patients diagnosed with localized prostate cancer, the gold standard treatment is the radical prostatectomy. It is most often used during early stages (Stages T1 and T2), when the cancer is encapsulated within the gland. Surgery may help prevent further spread of the cancer. If the tumor is small and has not spread outside of the prostate gland, then surgery may cure the disease. Nerve-sparing radical retropubic prostatectomy involves a surgical cut in the lower abdomen. The entire prostate and attached seminal vesicles are removed, along with a small part of the bladder next to the prostate. If necessary, nearby pelvic lymph nodes are removed as well. The advantage of the nerve-sparing procedure is that it allows the surgeon to identify the nerves on either side so that they can be avoided if possible. The benefit to leaving these nerves alone is that some men will have a better chance of achieving erections after surgery.
Disadvantages | Robotic Surgery | CaverMap™
Minimally Invasive Robotic Surgery (da Vinci System)
Traditionally, radical prostatectomy was performed through a large incision in the lower abdomen. Because the incision opens the pelvic cavity, the patient often would experience significant blood loss during the surgery. Moreover, the need for the incision was associated with increased perioperative pain and a longer recovery time.
Minimally invasive
robotic radical prostatectomy allows the surgeon to perform essentionally
the SAME radical prostatectomy without the need for the large incision.
The robotic approach, utilizing the da Vinci Surgical System, provides
easier access to the patient’s internal
anatomy through 5 one cm incisions. The robotic instruments, which are
completely controlled by the surgeon, have wrist and hand like maneuverability,
which allows the surgeon to move them like his own hands during traditional
open surgery. The surgeon, during the minimally invasive robotic prostatectomy,
is performing the operation while looking through a viewer that provides
him/her with an excellent 3-dimensional visualization and 10-fold magnification.
Dr. Seth Lerner, Director of the Prostate Program, states that “with
the 3-D magnified view, I am more able to precisely identify and preserve
the delicate structures that surround the prostate. This includes the
sphincter muscles, which are responsible for urinary control, plus
nerves and blood vessels, which are responsible for potency during
the curative cancer operation. The same principles that I have used
for years during standard open nerve sparing (for the preservation
of sexual function) radical prostatectomy are applied to the robotic
surgery. The da Vinci system is not a replacement for surgical skill
and experience or extensive knowledge and understanding of pelvic anatomy.
It is merely another tool such as an advanced scalpel and microscope
that I can use to perform radical prostatectomy while maintaining the
patient’s quality of life.”
Potential patient benefits of robotic prostatectomy include:
- Reduced or minimal post-operative pain
- Reduced blood loss and thereby reduced transfusion rates
- Shorter hospital stay (many patients are discharged home one day after the procedure)
- Faster recovery period and thereby quicker return to work
- Quicker catheter removal
- Reduced scarring
- Greater surgical precision, which, in turn, potentially means more accurate removal of cancer and reduced risk of impotence and incontinence
Although there are not yet long term data with respect to cure rates with robotic prostatectomy, the pathological results are comparable to those with open radical retropubic prostatectomy. As such, one can expect the same excellent long-term cure rates realized with the traditional surgery.
For more information about robotic prostate surgery at White Plains Hospital Center, contact Seth Lerner, MD at 914-949-7556.
For more information about the cancer program at White Plains Hospital Center, click here
Disadvantages of surgery
The disadvantage of a prostatectomy is that it is a major operation that requires hospitalization and can produce side effects. The possible side effects include impotence, incontinence, and narrowing of the urethra, which can make urination difficult. Although impotence can occur in a large number of patients, the chance of impotence is lower with the nerve-sparing technique. In general, impotence is more likely to occur in older patients, especially those older than 60 years of age. The risk of impotence is even greater for men older than 70 years of age. Incontinence occurs in only a small percentage of patients.
CaverMap™ Surgical Aid
One of the frequent complications of prostatectomy is impotence, often caused by damage to nerves that lie close to the prostate during the surgical procedure. The CaverMap is intended to guide surgeons in mapping, and ultimately sparing, cavernous nerves that are responsible for potency. Preserving these nerves offers significant clinical and quality-of-life benefits. Use of the CaverMap adds about 15 minutes to the total surgery time. The device does not cause any risks to the patient and greatly decreases the risk of impotence. Some studies have shown about 70 percent of men having CaverMap were able to obtain erections versus 50 percent of men who didn’t have the procedure. Doctors say CaverMap is only for men with localized prostate cancer. When cancer is more widespread, sparing the nerves may leave some of the cancer behind.
Radiation | Prognostic Indicators | Therapy for Localized Prostate Cancer | Treatment of Metastatic Prostate Cancer