The Role Of Surgery In Prostate Cancer Care
- Prostate cancer treatment decisions should be personalized and consider factors like age, health status, and patient expectations as “one size does not fit all.”
- Surgery, particularly robotic surgery, can be an option — sometimes even in advanced cases — due to improved outcomes and minimized side effects, according to specialists.
- Robot-assisted prostatectomy [removal of the prostate gland] offers advantages like less blood loss, less pain, shorter hospital stays, and a quicker return to normal activity compared to traditional open surgery.
- Patients should work closely with their teams to weigh the risks and benefits of each potential treatment approach.
When it comes to surgery, this approach was typically only considered for patients with earlier-stage disease in the past — that’s changing now.
Read MoreWhat Doctors Mean By ‘Advanced’ Disease
The term “advanced disease” can mean different aspects of a disease within a spectrum. Specialists call prostate cancer advanced when it has grown beyond the gland itself (and it is not restricted to the prostate anymore).Some terms that are part of this classification include:
- Locally advanced: This means the tumor has pushed through the capsule that exists around the prostate, or invaded other nearby organs such as the seminal vesicles or the bladder neck.
- Node-positive: This is when cancer is found in pelvic lymph nodes (small drainage structures found throughout our body), but nowhere else.
- Metastatic: This means exams show disease deposits in bones, distant lymph nodes (other than pelvic), or other organs.
These stages form the backbone of National Cancer Institute (NCI) treatment summaries and clinical guidelines.
How Robotic Surgery Has Improved Results
Nowadays, most U.S. prostate removals are done with the robotic system. Experts tell us that compared with the traditional open operation, robot-assisted prostatectomy generally means: less blood loss, less pain, shorter hospital stay, quicker return to normal activity, and fewer days with a catheter.
American Urological Association reports also show that same-day discharge from the hospital is feasible for many patients and can lower overall costs without raising complication rates. Modern robotic techniques are also linked to better recovery of sexual function than older open procedures.
Long-term cancer control appears similar between open (conventional approach) and robotic surgery when the operation is performed by an experienced team.
Balancing Benefits and Risks
The prostate surgery (prostatectomy) — open or robotic — can provide excellent cancer control in the right setting, but every operation carries risks. Some risks associated with surgery include urinary incontinence, changes in sexual function, lymph fluid collections, blood clots, infection, or the need for additional treatments.
Age, other illnesses, tumor features, and access to high-volume centers all shape whether the potential benefits outweigh these drawbacks.
It’s also important to know that as the patient, the decision is ultimately yours, so it’s critical to make your needs clear when discussing treatment with your team.
“The decision has to be made by the patient, but it’s an informed decision-making,” Dr. Razdan explains. “As a clinician, as a urologist, I put out the options to the patients and then they have to decide. My job out there is to guide them as to what the outcomes are with the different modalities, and then they have to make a decision. One size does not fit all.”
Questions To Ask Your Doctor
- Is my cancer considered low, intermediate, or high risk?
- Given my age and overall health, will I gain enough benefit from surgery?
- What additional treatments might I need after surgery?
- What short-term side effects should I expect after robotic surgery, and how long do they usually last?
- What options do I have if I decide against surgery now, or if the cancer returns later?
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