Robotic Prostate Surgery Details
Using the advanced surgical system, miniaturized robotic instruments are passed through several small keyhole incisions in the patients abdomen to allow the surgeon to remove the prostate and nearby tissues with great precision. This is much less invasive than a conventional radical retropubic prostatectomy, which involves an abdominal incision that extends from the belly button to the pubic bone.
During robotic-assisted radical prostatectomy, a three-dimensional endoscope and image processing equipment are used to provide a magnified view of delicate structures surrounding the prostate gland , allowing optimal preservation of these vital structures. The prostate is eventually removed through one of the keyhole incisions.
For most of the surgery, the surgeon is seated at a computer console and manipulates tiny wristed instruments that offer a range of motion far greater than the human wrist. The surgery is performed without the surgeon’s hands entering the patients body cavity.
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Compared with traditional open surgery, patients who undergo robotic-assisted radical prostatectomy experience:
Less blood loss
Shorter hospital stays
Faster recovery times .
Why Is It Important To Know The Risk Level Of Your Cancer
Knowing whether your cancer is low-risk or higher-risk is important when you are making treatment choices.
The risk level of your cancer is based on the results from your tests and examinations, such as the PSA test, digital rectal examination, and prostate biopsy.
- Low-risk means that the cancer isn’t likely to grow right away. There is a chance it may grow so slowly that it never causes symptoms.
- Medium-risk means that the cancer is more likely to grow. Most men will likely need treatment with radiation therapy or surgery.
- High-risk means that the cancer will most likely grow right away. Men will likely need treatment with radiation therapy or surgery.
Your doctor can help you understand your test results and the risk level of your cancer. Then you can compare your treatment options and make the choice that seems best to you.
What Is Localized Prostate Cancer
Prostate cancer is the abnormal growth of cells in the prostate gland. Localized prostate cancer has not spread outside the gland. Early prostate cancer usually doesn’t cause symptoms.
Prostate cancer is the most common cancer in men. Most men who get it are older than 65. If your father, brother, or son has had prostate cancer, your risk is higher than average.
Men of African descent have the highest rates of both prostate cancer and deaths from it.
About 21,000 men are diagnosed with prostate cancer in Canada every year.footnote 1 In the United States, about 12 out of 100 men in the U.S. will be diagnosed with prostate cancer sometime in their lifetime.footnote 2 But most men who are diagnosed with prostate cancer don’t die from prostate cancer.
Unlike many other cancers, prostate cancer is usually slow-growing. When prostate cancer is found earlybefore it has spread outside the glandit may be cured with radiation or surgery.
Prostate cancer that has grown beyond the prostate is called advanced prostate cancer. Treatment choices are different for that stage of cancer.
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What Are Prostate Cancer Treatment Side Effects
Some prostate cancer treatments can affect the bladder, erectile nerves and sphincter muscle, which controls urination. Potential problems include:
- Incontinence: Some men experience urinary incontinence. You may leak urine when you cough or laugh, or you may feel an urgent need to use the bathroom even when your bladder isnt full. This problem can improve over the first six to 12 months without treatment.
- Erectile dysfunction : Surgery, radiation and other treatments can damage the erectile nerves and affect your ability to get or maintain an erection. Some men regain erectile function within a year or two . In the meantime, medications like sildenafil or tadalafil can help by increasing blood flow to the penis.
- Infertility: Treatments can affect your ability to produce or ejaculate sperm, resulting in male infertility. If you think you might want children in the future, you can preserve sperm in a sperm bank before you start treatments. After treatments, you may undergo sperm extraction. This procedure involves removing sperm directly from testicular tissue and implanting it into a womans uterus.
Treatment Options For Localized Prostate Cancer
If you are diagnosed with low-risk prostate cancer, you may be presented with a number of different treatment options. The most common include:
- Active Surveillance: Your doctor may want to monitor your disease to see if treatment is necessary. With active surveillance, you will have regular check-ups with your doctors, and he or she may perform biopsies regularly. If your test results change, your doctor will discuss your options for starting treatment.
- Watchful Waiting: While some doctors use the terms active surveillance and watchful waiting interchangeably, watchful waiting usually means that fewer tests are done. You will still visit your doctor regularly, but your doctor will discuss changes in your health as they relate to managing your symptoms, not curing your disease.
- Prostatectomy: Removal of the prostate, called prostatectomy, is an option that has a strong likelihood of removing your cancer since you are removing the gland where it is located. However, this is an invasive procedure that can lead to other issues, which will be covered later.
- Radiation: Your doctor may suggest radiation as a means of therapy that targets tumors with radiation, usually through daily treatments in a hospital or clinic over multiple weeks.
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Life After Treatment: Alan Weiners Story
When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.
The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.
Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.
I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.
Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.
Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
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Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
Types Of Prostate Surgery
There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.
Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of;side effects.
The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.
Keyhole surgery .
- Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon ;controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
- Keyhole surgery by hand; As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.
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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
It’s possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
After a radical prostatectomy, you’ll no longer ejaculate during sex. This means you will not be able to have a child through sexual intercourse.
Prostate Surgery Recovery Timeline
Prostate surgery recovery varies from person to person depending on how their body heals naturally and how severe the condition was prior to surgery.; Here are some tips to help you through your recovery.
Prostatectomy typically requires;general anesthesia;and a hospital stay of 1 to 4 days. Your physician will have you walk around the day of or the day after your procedure.;You may also be instructed to do little exercises while you are in the bed. All prostate cancer patients will be discharged from the hospital with a urinary catheter in place. A catheter is a thin flexible tube that is usually left in your;bladder for 1 to 2 weeks to help drain your urine. Your doctor will give you specific guidelines about how to;care for your catheter;at home. Bladder control may be difficult for a few months after the catheter is removed.;Some males will need a urinary catheter for 5 to 10 days after surgery.
Refrain from driving for 1 week after your prostate surgery. Do not drive until your catheter is removed. Also, be aware that you should not drive on prescribed pain medications unless a doctor says its ok. After one week, it should be safe to resume driving and begin most daily activities.
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Causes And Risk Factors
The causes of prostate cancer are not fully understood, although it is believed that multiple factors can contribute to your overall risk, including your family background, ethnicity, diet, and environmental factors.
One out of nine men will develop prostate cancer during his lifetime. African American men are 60 percent more likely to develop prostate cancer, and twice as likely to die from prostate cancer, in comparison to Caucasian men.
A man with a father or brother diagnosed with prostate cancer has an increased chance of also being diagnosed with prostate cancer. Some experts suggest that men with a higher risk of developing the disease begin testing for it beginning at age 35, however no study has yet proven that lives are saved by testing at that age. The best advice is for men to make an informed decision.Men who served in the military during the Vietnam and Korean wars who were exposed to Agent Orange are at a higher risk for developing prostate cancer Sexual preferences and behavior are not risk factors for developing prostate cancer.
If Treatment Does Not Work
Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.
This diagnosis is stressful, and for many people, advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
People who have advanced cancer and who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with the health care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment, including a hospital bed, can make staying at home a workable option for many families. Learn more about advanced cancer care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
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What Else Do You Need To Make Your Decision
Check the facts
- Sorry, that’s not right. One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
- You’re right. One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
- It may help to go back and read “Get the Facts.” One treatment may be better for you than the other because of how long you might live , your other health problems, and how you feel about each treatment. You and your doctor can talk about what is better for you.
- That’s right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
- That’s not right. The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
- It may help to go back and read “Get the Facts.” The chances of side effects from surgery are lower if your doctor has done a lot of these surgeries.
1.How sure do you feel right now about your decision?
3.Use the following space to list questions, concerns, and next steps.
How Prostate Cancer Staging And Risk Stratification Affect Treatment Options
Your treatment choices are determined by several factors, including your cancers stage, aggressiveness and assigned risk stratification . Your age and current general health condition may also affect your choices.
Prostate cancer staging
Prostate cancer staging determines whether the cancer is confined to the prostate gland or whether theres evidence of metastasis, meaning its spread to other areas of the body.
Tools and methods to determine staging may include the prostate-specific antigen test, the digital rectal examination , the Gleason score and the American Joint Committee on Cancer TNM system, which provides information on the tumor, lymph node;involvement and metastasis of a cancer. Imaging tests, such as a PET/CT scan, may also help determine your cancers stage.
Localized, meaning theres no indication that the cancer has spread beyond the prostate
Regional, meaning theres evidence of cancer cells in nearby lymph nodes or tissue
Distant, meaning theres evidence the cancer has spread to other organs or body parts farther from the prostate
Almost 90 percent of prostate cancers are diagnosed at the localized or regional stage. The five-year relative survival rate for men diagnosed with prostate cancer at these stages is nearly 100 percent.
Prostate cancer risk assessment
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