If your prostate cancer profile is overwhelmingly positive and you have 7-10 years of expected healthy lifestyle, surgery will be recommended.
- Radical Robotic Prostatectomy
- Radical Open Retropubic Prostatectomy
- Radical Perineal Prostatectomy
- Laparoscopic Prostatectomy
Radical Robotic Prostatectomy:
With the advent of the da Vinci™ robot, Tulane University Health Sciences Center was among the first in the United States to acquire this advanced therapeutic option for management of prostate cancer. This technical innovation provides the surgeon with 3-D high definition viewing capabilities which enhances the surgical procedure so as to maintain quality-of-life issues which are of major concern to patients for management of their prostate cancer.
Besides drastically decreasing pain and blood loss, the robotic prostatectomy greatly enhances the technical aspects of the procedure because the surgeon has the option of up to 10x magnification to greatly facilitate the nerve-sparing option, which is now preferred in most patients who have early diagnosis of prostate cancer.
The surgeons on the Tulane Urology robotic team not only provide this state-of-the-art option here in New Orleans but also have traveled extensively teaching this new art of surgery in several states around the country. In addition, Tulane Urology is the only approved fellowship training site in the entire Gulf South.
Brief Description of the Procedure
After pre-operative discussion and adequate consent, the patient is given general anesthesia.
Laparoscopic trocars or ports are inserted into the abdomen to introduce a 3-D camera and the robotic working instruments. Additional trocars help the bedside surgeon to insert instruments, suture material, and drains.
The magnification, as mentioned above, greatly improves the vision of the surgeon and thus the surgical procedure is more precise as compared to most open radical retropubic prostatectomy.
The robotic procedure usually takes slightly longer than the open surgical procedure. However, the increased time usually is due to such factors as the robot set-up time, instrument turnover, or change time.
Most patients stay in the hospital overnight and are sent home after having a regular breakfast.
Most patient’s pain are managed postoperatively using anti-inflammatory agents such as ibuprofen (Advil™, Nuprin™).
As with all new technology, robotic surgery involves a significant learning curve. The importance of experience in robotic surgery is critical. The nerve-sparing approach is crucial to maintain quality of life as well as to ensure surgical margins are negative.
Potential patients should ask about their urologist’s experience using the da Vinci™ robot for radical prostatectomy.
Advantages to robotic surgery include:
- better visualization in 3-D
- less invasive
- less painful
- quicker recovery
- quicker return to normal activity
Radical Perineal Prostatectomy
Tulane is among the most experienced Departments in the country in performance of radical perineal prostatectomy. This approach is through an incision made in the perineum (between the scrotum and the anus). Those urologists who are specially trained in this low-morbidity approach offer this procedure. Recovery is usually quicker and return to normal activity is easier using this approach.
Who is eligible for Radical Perineal Prostatectomy?
Those who have multiple abdominal incisions, those with bowel problems including patients with J-pouches and are unable to have a robotic radical prostatectomy. However, the lymph nodes will need to be evaluated using newer imaging modalities such as PSMA scan.
Prior to the introduction of the da Vinci™ robot, Tulane Urology performed laparoscopic prostatectomy for the management of prostate cancer. This option is still used at several medical centers around the world. Ask your urologist about best surgical treatment option for you. Very often if both your PSA and Gleason score are low, there is no need for a pelvic lymph node dissection. The advantage of surgery includes removal of the prostate gland, which can effectively be monitored by serial PSA exams in the future. Radical prostatectomy has been shown to offer the best surgical long-term effectiveness to control your prostate cancer.
The side effects of Radical Prostatectomy Surgery include:
- bleeding, however blood transfusion requirement is only in a small percentage of patients
- urinary tract infection (A catheter drains your bladder for approximately two weeks)
- urinary incontinence
- impotency. it is now well known that the degree of impotency following radical prostatectomy depends on various factors. Under similar circumstances, the younger the patient, the higher the likelihood of preserving potency. Conversely, the older you are, the less likely it is that you will be able to maintain your potency in a satisfactory manner.
Following prostate removal, you will have lack of ejaculation, since the prostate contributes significantly to your ejaculation, thus you will be sterile after the procedure. However, approximately 30-50% of patients will have erections satisfactory to perform sexual intercourse. Patients may also require the assistance of oral medications, such as Viagra™; injectables, such as Caverject™; a vacuum erection device (VED); or implantation of a penile prosthesis that can be inflated prior to sexual intercourse. Our expert team in Tulane Urology’s Men’s Health Section will guide you through this journey of recovery.
Potency preservation is possible with a nerve-sparing prostatectomy. However, not all patients are candidates for potency-sparing prostatectomy. It depends on your prostate cancer profile.