Surgical Treatment of Prostate Cancer – Part 2

Surgical Treatment of Prostate Cancer

Robotic Prostatectomy

This procedure involves the use of advanced technology to guide surgical tools in order to minimize blood loss and precision of the procedure. The benefit of using Robotic Prostatectomy over other surgical modalities are many folds. For example:

• Robotic prostatectomy is associated with low morbidity and early return to normal day-to-day activities (as it is less invasive or aggressive).
• The post-surgical rehabilitation period is generally smooth (less pain and shorter stay in the hospital).
• The robotic procedure is highly precise and calculated, which minimizes the risk of nerve damage; hence the risk of sexual dysfunction is very low.

In most cases, localized cancer of prostate gland can be managed via prostatectomy alone (without requiring any other intervention). According to the study reported in the peer reviewed journal European Urology (1), investigators suggested that sophisticated treatments like robot-assisted prostatectomy are costly when compared to conventional surgical regimens but the health benefits are immense; both in short term and long term.

TURP

TURP (or transurethral resection of prostate gland) is widely used for the management of benign prostate hyperplasia (BPH); however, it can also be used to improve the urinary symptoms in advanced prostate malignancy.

As part of the procedure, the surgeon removes the prostatic tissue in the vicinity of prostatic urethra via resectoscope (that isinserted via penile tip) to allow unrestricted flow of urine. Once in place, the tissue is resected via laser or electricity generated heat.

The classic benefit of this procedure is; improvement in the quality of life of patient who cannot immediately afford surgery (due to advanced disease or other co-morbid issues).

Cryosurgery

This is classified as a minimally invasive procedure. In this procedure, two needles are inserted within the prostate gland with the help of ultrasonic guiding imagery. With this arrangement in place, the cancerous tissue is exposed to freezing temperatures leading to death of cancer cells and inhibition of abnormal growth.

Orchiectomy

This procedure involves the removal of testicles (the male gonads that are responsible for the secretion of testosterone). It is imperative to mention that surgical removal of testicles does not treat/ remove the existing prostate cancer; however, several research studies indicates that testicular removal helps in shrinking the size of a localized cancer by decreases the availability of testosterone for cancerous cell growth in the prostate gland.

References

1. Bolenz, C., Freedland, S. J., Hollenbeck, B. K., Lotan, Y., Lowrance, W. T., Nelson, J. B., & Hu, J. C. (2014). Costs of radical prostatectomy for prostate cancer: a systematic review. European urology, 65(2), 316-324.

2. Ramsay, C., Pickard, R., Robertson, C., Close, A., Vale, L., Armstrong, N., … & Soomro, N. (2012). Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technology Assessment.

3. Lowrance, W. T., Eastham, J. A., Yee, D. S., Laudone, V. P., Denton, B., Scardino, P. T., & Elkin, E. B. (2012). Costs of medical care after open or minimally invasive prostate cancer surgery. Cancer, 118(12), 3079-3086.

4. https://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-surgery