Surgery has several advantages over radiation and other non-surgical options. These advantages are:
- Examination of the surgically-removed prostate allows for accurate staging, enabling us to make rational decisions regarding the need for immediate treatment after surgery.
- Surgery provides relief of obstructive voiding symptoms by getting the prostate out of the way of the bladder.
- Overall side effects of surgery are no worse than those of radiation.
- Hormone therapy with TIP will not be necessary (unless after the operation a new, unsuspected degree of cancer spread is detected).
- The accuracy of PSA monitoring for relapse is much greater after surgery than after radiation and other non-surgical options.
- Salvage therapy (for recurrence) is effective and safe after surgery.
State of the Art Robotic Surgery for Prostate Cancer
Robot Assisted Radical Prostatectomy was FDA-approved for prostate cancer treatment in 2001. RARP improves accuracy, reliability, and reproducibility of surgery. Compared to open surgery, blood loss is less, hospitalization time is shorter, and men tend to recover bladder control and sexual function more quickly and to a better degree.
RARP generally takes between one and a half to three and a half hours. Thirty to sixty additional minutes are required when the lymph nodes are removed. After the operation, men wake up with a catheter that protects the new connection between the urinary bladder and the urethra. Most men will be able to go home from the hospital the following day. The catheter is removed a week later. Most can return to work within 2 to 3 weeks.
Preventative measures improve the likelihood of recovering erectile function. I recommend regular doses of Viagra. In addition, I recommend at least one dose (100 mg) of Viagra on the third day prior to surgery. There is preliminary evidence that this decreases the shock to the nerves. Six weeks after the operation, if men are getting at least partial erections, then continuing Viagra or a similar drug is probably fine. For men who want to be proactive and for men who are having zero erections, I recommend starting injection therapy. We teach our patients how to inject a small amount of medicine with a tiny needle directly into the penis. It is analogous to diabetics giving themselves insulin. With the correct dose, a full erection will result within about 10 to 15 minutes and last about an hour. This is repeated two to three times weekly at home. It keeps the penis healthy while the nerves are waking up. It will also allow the patient to have intercourse. Men under 65 who have good erections prior to surgery have about an 85 percent chance of having erections (without injection therapy) sufficient for intercourse within a year.
Twenty-five percent of my patients experience immediate return of complete bladder control. Fifty percent have no need for pads by 6 weeks; 85 percent are dry by 3 months; and 90 to 98 percent by one year. Results are influenced by a patient’s age, preoperative bladder control, prostate size and the nerve-sparing technique used. In the few men who do not regain urinary continence, medical therapy can sometimes be successful (Chapter 12). Death from prostate cancer after RARP is rare; most men recover completely and go on to live full and productive lives. Men who have recurrence after RARP can commonly be treated successfully with radiation.
ABOUT THE AUTHOR
Timothy Wilson, MD is a board-certified urologist who specializes in minimally invasive, laparoscopic, and robotic-assisted urologic oncology. He is one of the top six surgeons in the world, in terms of volume, that performs robotic-assisted laparoscopic prostatectomy. Dr. Wilson is a member of the American Urological Association and the Society of Urologic Oncology. Throughout his tenure that spans nearly 30 years, he has published numerous peer-reviewed articles and book chapters in the areas of urologic oncology, urinary reconstruction, and robotic surgery. In 1995, Los Angeles magazine deemed him one of 25 “Doctors who are making a difference,” and in 1998, he was voted “Professor of the Year” by urology residents in training at the University of Southern California School of Medicine.