Radical prostatectomy is the surgical procedure applied to get rid of prostate gland affected by cancer. This is often carried out when the cancer is still localized ( that is, still within the confines of the prostate cells). The surgical procedure is of two types: one is the open radical prostatectomy (ORP) and the Robot-Assisted Radical Prostatectomy (RARP).The former is much more invasive than the latter.
A recent study published in the European Urology journal has revealed that the applications of Robot-Assisted Prostate cancer surgery are much more successful than the open radical prostatectomy. The reason is that it provides men with better outcomes and fewer complications. The following extract throws more light into this publication:
Robot-assisted surgery is now both more common and far more successful than radical “open” surgery to treat prostate cancer in the United States, according to a new Henry Ford Hospital study published in the current issue of the medical journal European Urology. The research, led by scientists at Henry Ford Hospital’s Vattikuti Urology Institute (VUI), is the first to compare in a nationwide population sample the results of robot-assisted radical prostatectomy (RARP) to the standard surgical procedure, open radical prostatectomy (ORP).
The researchers found, based n a representative 20 percent sample of the U.S. that:
• 19,278 patients underwent RARP or ORP in 647 medical institutions between October 2008 and December 2009. • Of those, 11,889 underwent RARP and 7,389 underwent ORP. • More RARPs were performed at teaching institutions in urban locations, and a higher proportion of RARPs were performed at high-volume hospitals. • RARP patients were less likely than ORP patients to need a blood transfusion, less likely to have a prolonged hospital stay, and less like to suffer complications during or after surgery, including cardiac, respiratory, and vascular problems.
ORP involves opening the lower abdomen with a long incision, and removing the entire diseased prostate gland and some surrounding tissue in the hope of preventing the cancer from spreading to other parts of the body.
A similar procedure, known as RARP, is done through tiny incisions using minimally invasive laparoscopic surgery. Henry Ford Hospital pioneered the use of robots to assist surgeons in this delicate procedure, and the new study confirms earlier Henry Ford findings that RARP is now the most common technique in the United States for treating localized prostate cancer.
Prostate cancer is the most common “solid organ” malignancy and the second leading cause of cancer death in U.S. men. Radical prostatectomy became the standard treatment after it was shown that the surgery resulted in higher survival rates than “watchful waiting.”
But in the past 10 years, “we’ve seen a significant trend toward the use of minimally invasive approaches to RP for the treatment of prostate cancer, particularly in the U.S.,” says Quoc-Dien Trinh, M.D., a fellow at VUI and lead author of the study.
“While this evolution has been controversial, there have been few comparative studies. Most of those looked only at single institutions or single surgeons, and they were of poor evidentiary quality.”
Most significantly, the new study found “superior” results with RARP in virtually every outcome studied, including the amount of necessary blood transfusions, complications during and after surgery, and length of hospital stay.
At Henry Ford, which did much of the original work on robotic surgery for prostate cancer, 98 percent of patients go home within 24 hours of the operation and major complications are less than 2 percent, according to Mani Menon, M.D., director of Henry Ford’s Vattikuti Urology Institute.
In selecting the study’s subjects, researchers relied on the Nationwide Inpatient Sample (NIS) maintained by the Agency for Healthcare Research and Quality under the U.S. Department of Health and Human Services. Read the full article here.
Conclusively, since it has been confirmed by studies( the above inclusive) that prostate cancer can be effectively treated with the Robot- Assisted approach when compared to invasive surgery, it is quite important that you consider your option now. If surgery is mandatory for you, talk to your doctor about your realistic expectations. It is also important that you are aware of the side effects of this treatment. The truth is that even with robot assisted radical prostatectomy; everyone may not be the right candidate for the procedure. So, consult in details with your doctor to ensure you can undergo this treatment for early detected cancer of the prostate.
Benign prostatic hypertrophy or BPH is a medical condition that causes obstructive urinary symptoms in most men, especially in their old age as they pass 70 and approach 80. The symptoms of the disorder include reduced urine flow, increased frequency and urgency, dribbling, hesitancy, incontinence, and excess urination at night. There are instances in fact in which the disease affects men younger than 40, although that isn’t too common.
Also called prostate enlargement, one of the best known treatments for the condition is the transurethral resection of the prostate (TURP), in a surgical instrument called the endoscope or cytoscope is inserted in order to cut away the excess tissue. However, due to the limitations of that procedure, and to technological advancements that are meant to make everything that much easier, other techniques have been found to improve on the TURP.
Prostate laser surgery is a minimally invasive therapy that is used these days for the treatment of BPH. Just like with the TURP procedure, in this operation a portion of the prostate is removed; however this time it is done by the aid of a specialized laser. With this surgery, the man being treated is afforded better urinary retention than previously; and he may undergo the procedure in the event of medical therapy failure, a recurrent infection, and renal insufficiency.
Incidentally, prostate laser surgery may be employed also for the treatment of various other conditions that generally affect the male urinary and reproductive systems, such as bladder stones, and prostatic bleeding. During the procedure, an anesthetic is given to the patient to help him relax for the length of the operation. The cystoscope is then inserted along with a specialized laser fiber in order to remove the portion of the prostate blocking the bladder’s drainage. Because of the loss of continence that result from the trauma to the region, a catheter is left in the bladder just long enough for the man to regain control of his bladder fluids – the catheter is usually removed the next day.
Some of the important advantages of prostate laser surgery, especially over TURP include the aforementioned minimal invasiveness of the surgery in dealing with bladder outlet obstruction, and a shortened recovery period, which most men can appreciate if they have to get back to work in a hurry. Certainly, because of the improved precision of the process, the patient also experiences lower blood loss than if he had to undergo the conventional prostate surgery. There are side effects still, though, and they include some initial discomfort with voiding after the procedure; however, this fades within days. Some patients also take longer to recover their bladder control, but again, that fades. And with fewer scars, the man certainly has a lot to be thankful for
I don’t know of anyone under the sun who would rather not have one definitive fix-all solution to any ailment that there is… and without side effects too. But one should be so lucky – prostate cancer is definitely one disease that is not like that. Torn between several existing procedures that are meant to aid with the disease in some way, several new procedures for treating the disease continue to spring up all the time. Why? It’s because there is not definitive cure for the malignancy of the cells of the prostate gland, and worse, all the existing treatments have their own side effects that may not be very palatable to deal with.
Surgery is one such. Called a radical prostatectomy when used for dealing with prostate cancer, it can be done through an incision in the abdomen of the patient or through an incision in the perineum. Either way, the intention is to remove the prostate gland, and with it the cancerous tumor that is growing with it. One might then wonder how or why there should be any side effects to the therapy.
Here it is: besides the common risks that are synonymous with any kind of surgery, the unique location of the prostate gland specifically poses a special problem by itself. The gland is located underneath the bladder, partially surrounding it. It also is very close to the tube leading from the bladder to the penis called the urethra. As a result it is extremely difficult for anything to affect the prostate gland without affecting either the bladder or the urethra, or both.
This is why some of the symptoms of prostate cancer include problems with urinary function and with sexual performance. This is why there are quite a number of complications or side effects that occur from the prostate surgery that is intended to treat the condition and perhaps cure it. One of those side effects is the loss of continence or urinary control.
After the surgery, most men find it difficult to ‘hold their leaker,’ as it is called in vernacular. At least for several days they have to wear a catheter around their ankle with a tube from their penis to the sac to collect urine. For the most part though, a good portion of continence returns after a while – sometimes up to ninety percent of it.
But even graver is the fact that the nerves that control erection are closely located to the prostate – lining it on the sides even. As a result, even with nerve sparring to protect and avoid damage to the nerves, many men end up impotent and unable to achieve a proper erection again for the rest of their lives. Some semblance of it returns after a few years, but for the most part the man has to do it with medications (Viagra), which may or may not work.