Prostate Cancer

Prostate cancer is the most common cancer found in men in the western world and remains among the most common cancers in men worldwide and accounts for many deaths each year. Although some of these cancers are very slow growing and when found in the more elderly men, can be managed expectantly, many of these cancers behave more aggressively and will lead to early death if not treated. The decision on the appropriate management of individual cancer depends on the stage of the cancer, its aggressiveness as predicted by the Gleason’s score of the cancer from the biopsy material and the sufferer’s age and general condition. Generally, active treatment is appropriate in younger sufferers, even those with cancers not thought to be too aggressive as these individuals have longer life expectancy which can still be shortened by a slow growing cancer. Very aggressive cancers are generally treated actively, even in fairly aged individuals as these cancers drastically curtail one’s life expectancy. Generally, your urologist will be best placed to offer you advice on the appropriate course of action.

The extent of growth of all cancers is classified using a staging system which tells us the limit of the cancers. Generally, early stages imply that the cancer is limited to the organ of origin and are potentially curable whereas late stages imply that the cancers have grown beyond the confine of the organ of its origin. These cancers are generally no longer curable. For prostate cancer, most urologists use the TNM staging system to classify the stages of prostate cancer.

T1	Your doctor can’t feel the tumuor or see it with imaging such as transrectal ultrasound.
T1a	The cancer is found incidentally during a transurethral resection (often abbreviated as TURP) for benign prostatic enlargement. Cancer is present in less than 5% of the tissue removed.
T1b	The cancer is found after TURP but is present in more than 5% of the tissue removed.
T1c	The cancer is found by needle biopsy that was done because of an elevated PSA.
T2	Your doctor can feel the cancer when a digital rectal exam (DRE) is done, but it still appears to be confined to the prostate gland.
T2a	The cancer is in one half or less of only one side (left or right) of your prostate.
T2b	The cancer is in more than half of only one side (left or right) of your prostate.
T2c	The cancer is in both sides of your prostate.
T3	The cancer has begun to spread outside your prostate and may involve the seminal vesicles.
T3a	The cancer extends outside the prostate but not to the seminal vesicles.T3b: The cancer has spread to the seminal vesicles.
T4	The cancer has spread to tissues next to your prostate (other than the seminal vesicles), such as your bladder’s sphincter (muscles that help control urination), your rectum, and/or the wall of your pelvis.

Like all cancers at their early stages, prostate cancers at stages 1 and 2 are curable as these cancers are deemed not to have grown beyond its organ of origin. In this instance, the total removal of the prostate and therefore the cancer which is contained therein often results a cure. However, the surgically inaccessible location of the prostate makes surgical removal (prostatectomy) a challenge to any surgeon. The operation requires a large lower abdominal incision and often results in massive bleeding requiring blood transfusion. The repair work after removal to re-establish the normal urinary passage is also technically challenging. As the prostate is situated just upstream of the urine passage and its valve (sphincter) control mechanism and the penis, surgery can compromise urine continence and often affects erection of the penis subsequently. However, despite all these considerations, surgery is still favoured by most sufferers because of its good outcome in terms of cancer control and cure.

Effort was made to reduce the gravity of prostatectomy by the adoption of keyhole surgical techniques but because of the location of the prostate and confinement of space, this was technically very difficult and not very successful until the advent of the Da Vinci® operating system. This robotised operating system enhanced with high definition stereoscopic (3-D) vision and the added manoeuvrability of its mounted operating instruments provides surgeons for the first time the means of drastically reducing surgical invasiveness with outcome surpassing that of conventional keyhole surgery. For prostate cancer, once trained and adept. A surgeon can perform the operation of prostatectomy using the Da Vinci® in the time it takes for the open surgery. Immediate post-operative outcome is vastly superior and long term functional outcome either matching or often surpassing that achievable with open surgery. Globally, Da Vinci® prostatectomy has now become the standard of care for prostate cancers in many well-known institutions.

Da Vinci® prostatectomy is performed using the da Vinci Surgical System, a state-of-the-art surgical platform. By overcoming the limits of both traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.

As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.

While clinical studies support the use of the da Vinci ® Surgical System as an effective tool for minimally invasive surgery for specific indications, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation.

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