PORTER ROBOTICS INSTITUTE FACT SHEET
Condition: Prostate Cancer
Robotic Procedures: Robotic Prostatectomy
If you or someone you know has recently been diagnosed with prostate cancer, you should know
about the treatment options available today. Below you’ll find an overview of prostate cancer, plus
information about treatment options, including Robotic da Vinci® Prostatectomy. With robotic
surgery, you should experience less bleeding, shorter recovery times and less post-operative pain.
Prostate Cancer
Prostate cancer is typically a slow-growing cancer that starts in your prostate gland. The prostate is
a small, walnut-sized structure that wraps around your urethra, the tube that carries urine out of
your body. Prostate cancer is the most commonly diagnosed cancer among American men today, but
thanks to early detection and improved treatment methods, death rates associated with the disease
have declined significantly.
Risk Factors
You’re at greatest risk for prostate cancer if you’re an African-American man or a male of any race
that has a father, brother, or uncle with prostate cancer. Age is an individual risk factor for prostate
cancer. It is rarely diagnosed before age 40, but the risk significantly increases after the age of 50.
Other risk factors include exposure to Agent Orange and a high-fat diet.
Symptoms
Most commonly, prostate cancer is diagnosed without any signs or symptoms of prostate problems.
Please keep in mind that if you experience any of the following symptoms, they could possibly
indicate prostate cancer, but most commonly they likely represent symptoms attributable to benign
prostatic hyperplasia (BPH), non-cancerous enlargement of the prostate. Please consult a physician
for any of the following symptoms: slowing of the urinary stream, dribbling or leakage of urine,
straining to urinate, sensation of poor bladder emptying, blood in the urine or semen, bone pain or
tenderness most often in the lower back and pelvic bones.
Diagnosis
Prostate cancer is typically diagnosed only after an abnormal screening test. Doctors screen for
prostate cancer in men with a digital rectal examination (DRE) and a blood test for prostate specific
antigen (PSA). When an abnormal screening test is discovered, a transrectal ultrasound-guided
prostate biopsy is performed to make the diagnosis of prostate cancer. Tissue from the prostate is
viewed underneath a microscope by a pathologist trained to identify prostate cancer.
Treatment
Treatment options for prostate cancer may include conservative management (active
surveillance/watchful waiting), radiation therapy (brachytherapy, IMRT/IGRT, proton beam or
standard external beam), cryotherapy ablation, surgery (open prostatectomy, laparoscopic
prostatectomy, robotic-assisted laparoscopic prostatectomy), and experimental treatments (high-
intensity focused ultrasound [HIFU] and focal therapy). Robotic-assisted laparoscopic (da Vinci®)
prostatectomy is now the most common treatment method for prostate cancer selected by men in the
United States.
Outlook (Prognosis)
Since the introduction of PSA screening the death rate from prostate cancer has decreased by
approximately 30%. This reduction is probably in part due to PSA screening and also because of
improvements in prostate cancer treatments. If prostate cancer is localized (contained) in the
prostate, patients have a greater than 90% chance of being cured by most prostate cancer treatments.
Prostate cancer is very difficult to cure once it has spread outside the prostate gland.
Robotic Prostatectomy
One of the most common treatments for prostate cancer involves the surgical removal of your
prostate gland, known as radical prostatectomy. Traditional radical prostatectomy requires a large six
to seven inch incision that commonly results in substantial blood loss, a lengthy and uncomfortable
recovery and potentially a higher risk of impotence (erectile dysfunction – ED) and urinary
incontinence (leakage of urine).
The potential advantages of a Robotic (da Vinci®) Prostatectomy compared to a traditional open
prostatectomy include:
decreased blood loss
shorter hospital stay
less post-operative pain
quicker recovery
quicker return to work
improved cosmetic results
Incision Comparison: Open Surgery vs. da Vinci® Surgery
A Robotic Prostatectomy is different. The da Vinci® surgical system includes a robot and a surgeon
console. The robot's four arms are positioned over and inside a patient during the surgery. The
surgeon console that is located just a few feet from the patient is a separate unit that controls the
movements of the robot inside the body and gives surgeons a magnified, high-definition (HD), and
three-dimensional (3-D) view of the body cavity. With robotic technology, a surgeon's hand
movements are motion scaled and any hand tremor is filtered resulting in perfectly translated precise
movements of the instruments.
In contrast to conventional surgical methods which require a single six to seven inch incision,
patients undergoing robotic surgeries receive several less than ½ inch incisions to begin the
procedure. During the surgery, a telescopic lens is inserted into one of the small incisions to preserve
the nerves, tissues and muscle. The cancerous tissue is then removed from the body through one of
the small incisions.
During the prostatectomy, you will be asleep (under general anesthesia), and also possibly receive
regional numbing medications (paravertebral nerve blocks). The following will also take place
during the procedure:
Your surgeon removes the prostate gland from the surrounding tissue.
Your surgeon attempts to preserve the neurovascular bundle (nerves allowing normal erectile
function) if your prostate cancer is low risk for localized spread outside the prostate gland.
Your surgeon then reattaches the urethra to the bladder. The urethra is the tube that carries
urine from the bladder out through the penis.
On occasion, your surgeon will also remove lymph nodes in the pelvis to check for cancer.
Your surgeon may or may not leave a surgical drain in your belly to drain extra fluids after
surgery. This drains fluid from the surgical area while you are recovering in the hospital.
A urinary catheter (Foley) is left in your bladder to drain urine and allow the connection of
the urethra and bladder to heal appropriately.
With any treatment for prostate cancer, there are always associated risks. Your surgeon will discuss
the risk and benefits of Robotic Prostatectomy with you.
The most common risks discussed with a Robotic Prostatectomy include:
Difficulty controlling urine
Erection problems
Urethral stricture, bladder neck contracture (tightening of the urinary outlet from
scar tissue)
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