Robotic surgery for prostate cancer
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One option you may be presented with is surgery.

This is an ideal treatment for men who meet the following criteria:

• Under 75 years of age

• A significant cancer (not suitable for surveillance)

• Fit enough for major surgery

• No previous surgery or radiotherapy to the rectum

Why choose surgery?

Surgery has certain advantages over radiotherapy and brachytherapy (radioactive rods or seed pellets inserted into the prostate) including:

• Surgery has the highest cure rate and chance of long-term survival

• It is a single ‘one-off’ treatment, whereas radiotherapy takes several months and dozens of hospital visits, often requiring chemical castration at the same time for up to 3 years for higher grade (gleason 8-10) cancers

• It can be followed by radiotherapy (even years later) in the small number of cases were cancer recurs in the area that the prostate was previously removed; surgery - on the other hand - is usually not possible when cancer recurs after radiotherapy

• It usually improves urinary symptoms (improved urine flow, less waking at night, etc) in men with bothersome urinary symptoms, whereas radiotherapy usually worsens these symptoms in the short and long-term

• It avoids the risk of later developing severe bleeding or cancer of the bladder and rectum, which can each occur in 1 in 30 to 50 cases ater radiotherapy due to radiation damage

• It reduces the risk of scar tissue causing a recurrent and severe blockage of the urethra (urethral stricture) which does occur after radiotherapy in 1 out of 20 cases.

Unfortunately, not all men are suitable for surgery, for example:

• Unfit for major surgery e.g. recent heart attack or stroke or unable to stop blood thinning medications

• Advanced age, especially over 75 years of age

• Previous radiotherapy to the prostate or rectum

• Unwilling to accept the side effects or risks (e.g. jehovah’s witness, unwilling to accept weakness of erections or incontinence).

Some men may be suitable for and better suited to radiotherapy, focal ablation therapy, active surveillance or hormone therapy. I am always happy to talk through the pros and cons of each treatment and together find the treatment best suited to your cancer, your life situation and your medical history.

What are the risks?

Men choosing surgery need to understand and accept the risks and side effect of surgery:

• Most men experience temporary incontinence (i.e. they leak urine when coughing, laughing or straining and thus have to wear incontinence pads); one in three no longer require a pad by 6 weeks, half by 3 months and 9 out of 10 by 1 year after surgery. Unfortunately, 1 in 10 men require pads long-term, in these men, a further minor procedure (sling or sphincter insertion) can usually fix the leakage.

• Most men experience temporary weakness of erections causing difficulty with sexual activity. If erections are normal before surgery and ‘nerve-sparing’ surgery is performed, erections will gradually improve over 1 -2 years after surgery, such that three out of four men will be able to achieve an erection strong enough for normal intercourse, although they may always require a tablet for assistance (e.g. viagra).

• One in ten men will require later treatment with radiation or hormone therapy (temporary chemical castration) for a cancer recurrence in the tissues or lymph nodes around the prostate that are microscopic and thus invisible at the time of surgery

• Although surgery is generally safe, rare but important risks include bleeding requiring transfusion, leak or stricture at the anastomosis, injury to the rectum requiring a temporary colostomy bag, injury to surrounding nerves/ vessels/ intestine.

What are the advantages of robotic surgery?

For prostate cancer, there are several key advantages of robotic surgery, especially when performed by an experienced robotic surgeon who is beyond their learning curve:

• Shorter hospital stay, faster return to normal activities

• Less pain

• Tiny wounds, less scarring

• Less blood loss

• Much lower chance of needing a blood transfusion

• Much lower risk of anastomotic stricture or leak

I have performed multiple research studies published in the world’s most prestigious urology journal (see link here and here) that demonstrate robotic surgery for a specialist robotic surgeon who has surpassed the learning curve after more than 100-200 cases also leads to:

1. Better chance of cancer cure

2. Faster return of urinary continence

3. Faster return of sexual function

For more information, see our page on robotic surgery.