Prostate cancer can be cured when it is localised to the prostate. It can be treated with radiotherapy or surgery. Over the past 20 years the sugical technique has evolved with the majority of operations now performed using the Da Vinci (Intuative surgical) robotic device. This allows for more easily performed surgery to remove the prostate (radical prostatectomy) and seems to produce an earlier return to continence, lower blood loss, and a reduced hospital stay. Surgeons at Manchester Urology have been at the forefront of developing minimally invasive (keyhole) treatment of prostate cancer for the past 15 years.
When a patient have been diagnosed with prostate cancer we will need to determine whether this is a cancer that can or needs to be treated as some lower grade cancers can be safely managed by observation only. All cancers identified by the Manchester Urology team will be reviewed at a specialist multi-disciplinary team meeting (sMDT) and discussed by surgeons, oncologists, histo-pathologists and radiologists. If it is determined to be a cancer that requires treatment then they will be offered a choice between robotic surgery and radiotherapy (both external beam and brachytherapy). Other novel therapies such as High Intensity Focused Ultrasound (HIFU) can also be discussed if appropriate. As part of the assessment process the patient will have had an MRI scan and if required a CT scan and a bone scan. The patient will need to see one of our surgeons and an oncologist as well as specialist prostate cancer nurses so that they can make a fully informed decision as to which treatment is the most suitable for their cancer.
Robotic prostate cancer surgery is fast becoming the leading method of prostate removal for cancer and has advantages over the open surgical method in the length of stay in hospital and speed of recovery.
Patient information - what to expect
For patients undergoing a robotic prostatectomy they can expect an overnight stay in hospital after admission on the morning of surgery. For morning operations the patient needs to be starved from midnight but no other preparation. The operation takes about 2-2.5 hours and there are 5 small holes used for allowing the robotic arms into the abdomen to perform the operation.
The complications of surgery are those of general operations in the pelvis:
- Infection (covered with a single dose of anti-biotics at the time of the operation), Bleeding (although the need for a blood transfusion is less than 1%) and deep vein thrombosis which is minimized by using small patient use injections into the skin of the abdomen for a total of 28 days (the nurses will show the patient to perform this simple task before discharge)
The complications of keyhole surgery:
- Injury to bowel (this is carefully checked for at the end of the procedure and occurs in less than 1% of cases)
The complications of surgically removing the prostate:
- Urine leak post-operatively which usually settles with the catheter;
- Urinary Incontinence (about 5% of patient will require a further procedure for continued leakage although a period of urinary leakage post-operatively is normal and tends to last for longer in the over 65’s.
- Erectile dysfunction is variable. In general if both nerves can be safely spared (depending on the extent and location of the cancer) then in patients with good erections prior to the procedure the chances of getting erections following the procedure are good and improve the younger the patient is at the time of surgery
Patients go back to the ward after surgery with a catheter and occasionally an abdominal drain. If a drain has been inserted then this is usually removed on the first post-operative day. A urinary catheter is left in place and the patients are discharged on the first post-operative day and seen 10 days after surgery for the catheter removal and removal of the surgical skin clips.