Prostate Cancer Surgery

Prostate Cancer and Robotic Radical Prostatectomy (Prostate Cancer Surgery)


If you or your loved one have been diagnosed with prostate cancer, most likely you are feeling a plethora of emotions- anxiety, confusion, even fear. To avoid undue stress and anxiety, it is recommended that you acquaint yourself thoroughly with the various aspects of this type of cancer.

What is Prostate Cancer?

Prostate is gland which is found only in males. It is located below the bladder and in front of the rectum. It is about the size of a walnut, but can be much bigger in older men.

Prostate cancer begins when cells in the prostate gland start growing uncontrollably. Most prostate cancers grow very slowly, some may spread quickly. In fact, it can be such a slow-growing cancer that many men never feel the effects of the cancer during their lifetimes unless diagnosed first.

Prostate Cancer Surgery in India

Types of Prostate Cancer

Almostall the prostate cancers are categorized as ‘adenocarcinomas’, which develop from the prostate gland cells responsible for the prostate fluid that becomes part of the semen.

The following are some other types of prostate cancers, but are generally rare:

  • Small cell carcinomas
  • Transitional cell carcinomas
  • Sarcomas
  • Neuroendocrine tumours

Some Key Facts about Prostate Cancer

  • After skin cancer, prostate cancer is the second most common cancer among men. In fact, about 1 in 7 men will get this cancer during his lifetime.
  • Prostate cancer is the second leading cause of cancer death in men in the United States, after lung cancer.
  • The risk of prostate cancer is higher for older men, and is quite rare for men under 40 years of age. Almost 60% of the cases are found in men above 65 years of age.
  • Prostate cancer can be a serious disease, but is not as fatal. In fact, the 5-year survival rate for prostate cancer in most men is 99%.

The exact cause of prostate cancer is not known, but researchers believe there are certain risk factors which cause the prostate cells to turn cancerous.

In very simple terms, cancer of prostate is caused when the DNA of a normal prostate cell changes. Such changes to a person’s DNA can be either inherited at birth or acquired during the lifetime.

Following are the main prostate cancer risk factors:

  1. Advanced Age: Almost 60% of prostate cancer cases are found in men above 65 years of age. It is rare in men below 40, and its probability increases rapidly after 50.
  2. Family History: Although a lot of cases are observed in men without any family history of prostate cancer, it does seem to run in certain families, indicating a genetic factor. The risk doubles for a man with a father or brother having this cancer.
  3. Ethnicity: Prostate cancer is more likely to occur in African-American men than white, Asian, and Hispanic/Latino men. The answer to why certain races are more affected than other is not yet clear.

Apart from the above, there are some more factors listed below whose exact effect on prostate cancer is not known:

  1. Diet high in red meat, calcium and dairy foods, and low in fruits and vegetables.
  2. Obesity and smoking.
  3. Exposure to certain chemicals.
  4. Inflammation of the prostate, vasectomy and sexually transmitted infections.

Usually early stage prostate presents no symptoms, and hence, gets diagnosed only in the later stages when these symptoms become more pronounced.

Following are some of the main signs and symptoms of prostate cancer:

  • Frequent urination, especially at night
  • Problems in urination, such as pain, burning or weak urinary stream
  • Blood in the urine
  • Blood in the semen
  • Inability to get an erection (erectile dysfunction)
  • Pain in the back, chest, or back
  • Weakness or swelling in the legs and feet
  • Difficulty in sitting down
  • Loss of bladder or bowel control

However, most of these symptoms can also be caused by other non-cancerous conditions such as enlarged prostate, urinary infections, etc. And hence, the exact cause of the above problems can only be determined by a proper diagnosis by a doctor.

The following are the various methods used by a doctor to determine the presence of prostate cancer:

Physical Exam

In this you doctor might ask you about any problematic symptoms you having, family history and other risk factors. He may also conduct a Digital Rectal Exam (DRE) to feel for any bumps on the prostate that may indicate presence of cancer. Based on this initial assessment, he may order further tests.

PSA Blood Test

The Prostate-Specific Antigen (PSA) blood test is one of the first tests done, mostly in men with no symptoms, to screen for cancer.

PSA levels under 4 nanograms per milliliter (ng/mL) of blood are generally considered normal, but this cannot be ascertained without a biopsy. As PSA level increases, the chance of having prostate cancer does too.

Trans-Rectal Ultrasound (TRUS)

In this test, a small probe is placed in your rectum and transmits a black and white image of the prostate onto a computer. TRUS is often used PSA level is high or an abnormal DRE result is seen.

Prostate Biopsy

If any of the above tests indicate to the doctor that cancer may be present, he will do a prostate biopsy.

In this procedure, few small samples of the prostate gland are removed using a thin hollow needle, and observed under a microscope to see if they contain cancer cells. If yes, it is given a grade called Gleason Score.

Grade (Gleason Score) of Prostate Cancer

Prostate cancers are assigned different grades based on the Gleason System, which tells how comparable the cancerous tissue is to the normal prostate tissue.

  • Grade 1: The cancer looks a lot like normal prostate tissue
  • Grade 5: The cancer looks very abnormal

Most cancers are graded 3 or higher, as grades 1 and 2 are not much relevant.

For more details on Gleason score, click here.

The ‘stage’ of a prostate cancer indicates the extent to which the cancer has spread, and is one of the most important factors in assessing prognosis and determining treatment options for the patient.

Prostate cancer stages are decided based on the following:

  • The results of prostate biopsy results including the Gleason score
  • The blood PSA level
  • The results of any other tests conducted by the doctor

Majority of doctors use the TNM System for determining the prostate cancer stages and their spread.

In this system, “T” stands for “Tumor” and indicates the size of the cancer; “N” stands for “Nodes” and informs if the cancer has spread to nearby lymph nodes or not; and “M” stands for “Metastasis” which refers to whether the cancer has spread to organs surrounding the prostate or not. By combining these three indicators, the prostate cancer stages are decided.

The following stages are most commonly used to describe the spread of the cancer:

  • Stage 1: The cancer is limited to the prostate and small enough not be seen in routine exams
  • Stage 2: The cancer is limited to the prostate but has grown in size
  • Stage 3: The cancer has spread beyond the prostate but is limited to nearby tissues
  • Stage 4: The cancer has metastasized (advanced) beyond the prostate into other organs and lymph nodes

Stage 4 prostate cancer is currently incurable, but there are certain treatment options that can help reduce the painful symptoms of advanced prostate cancer.

Once the stage of prostate cancer has been determined, the doctor will present to you a number of treatment options. It is advised that you take your time to think about each option’s pros and cons before making the final decision.

Following are some of the most common prostate cancer treatment options:

  • Active surveillance (or watchful waiting)
  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Hormone therapy
  • Bone-directed treatment
  • Cryotherapy (Cryosurgery)
  • Vaccine treatment

Although these treatments are mostly used one at a time, in certain cases one or more may be combined if the doctor sees fit.


Robotic Radical Prostatectomy (Robotic Prostate Cancer Surgery) at CRS

Till just a few years ago, the only surgery choice for men diagnosed with prostate cancer was open prostatectomy, which involved large incisions and many post-operative complications and complaints. However, as a result of modern technological advances, robotic surgery was introduced and its applications included radical prostatectomy as well. Robot assisted surgery done using state-of-the-art systems such as the ‘da Vinci Surgical System’ has gained immense popularity in the last several years, and with good reason. Robotic radical prostatectomy has proven itself to be a safe, less traumatic, and effective type of minimally invasive surgery.

What is Robotic Prostatectomy?

A minimally invasive surgery for prostate cancer done with the help of robotic surgical systems is called robotic prostatectomy. Such a procedure effectively combines the human insights and expertise of an experienced surgeon with the precision of controlled robotic instruments. And as a result, this type of procedure offers several benefits compared to open or non-robotic prostatectomy procedures.

Key elements of robot-assisted prostatectomy include:

  1. Advanced 3-D HD Visualization: The da Vinci surgery system has a camera that provides up to 10x magnification and an immersive view of the operative field to the robotic surgeon. As a result, the 3-D images are clear, bright and can be easily zoomed or rotated to provide the robotic surgeon with better visualization of the surgery than a human eye can provide.
  2. Highly improved precision: The da Vinci system has EndoWrist® instrumentation which provides dexterity and range of motion to the robotic surgeon much better than his human hands could. This robotic system also comes with Intuitive® Motion technology, which replicates the experience of open surgery for the robotic surgeon by preserving natural eye-hand-instrument alignment and intuitive instrument control. The system also removes tremors and unwanted movements caused by surgeon’s hands. As a result, the robotic prostate cancer surgery offers much higher precision to the surgeon than possible in open and traditional laparoscopic surgeries.
  3. Robotic Surgeon’s Console and Patient Side Cart: The robotic surgeon performs the procedure sitting at his console and controls the robot’s hand controls while looking into its vision system. Any changes required to the instrument during the surgery are generally handled by the OT nurse standing next to the console.

The patient side cart is positioned beside the robotic system such that its instruments and surgical tools have easy and unhindered access to the surgery site.


Benefits of Robotic Radical Prostatectomy (Robotic Prostate Cancer Surgery)

Robotic Prostatectomy has quickly become the treatment of choice for surgeons over open and laparoscopic surgeries, and with good reason.

A number of studies have been conducted (such as this and this) in the past few years to measure the effectiveness of Robot-Assisted Prostate Surgery, and to compare it with the results observed from open surgery. Almost all the researchers agree that Robotic-Assisted Radical Prostatectomy (RARP) has improved outcomes in the longer terms when compared with open surgery.

Robotic Prostatectomy Outcomes

At Centre for Robotic Surgery – A best prostate cancer surgery center in India, our highly experienced Robotic Surgeons use the da Vinci Surgical System to perform prostate cancer surgery in India, due to the numerous advantages of robotic surgery.

Some of the main benefits of Robotic Radical Prostatectomy are as following:

  • Lesser Blood Loss
  • Shorter Hospital Stay
  • Lesser Scarring
  • Lesser Pain
  • Shorter Duration of Catheterization
  • Better Ability to Preserve/Regain Sexual Function
  • Quicker Return of Urinary Function (Continence)
  • Faster Recovery and Return to Normal Routine
  • Lesser Surgeon Fatigue Causing Fewer Mistakes
  • Better Visualization and Movement for the Surgeons

Due to the proven benefits of Robotic Radical Prostatectomy, it has become the treatment of choice for robotic surgeons across leading global hospitals. However, do remember that the effectiveness of any surgery, especially robotic surgery, depends on the surgeon doing it. And hence, the more experienced and skilled a surgeon, the more successful any surgery will be.


Prostate Cancer and Robotic Radical Prostatectomy: Frequently Asked Questions

Being diagnosed with prostate cancer can bring a lot of questions to your mind. Below we have tried to answer some of the most commonly asked questions related to prostate cancer and robotic prostatectomy procedure.