Prostate Cancer Care

Posts Tagged ‘robotic’

A major study of patient satisfaction and regret following open prostatectomy and robot-assisted laparoscopic prostatectomy provides some important lessons for surgeons …

… and opens up the debate about  alternative prostate cancer care

The research, recently published in the European Journal of Urology, shows 19 per cent of patients regretted their treatment choice and patients who had robot-assisted surgery were most likely to be dissatisfied.

The authors suggest the regret is “possibly because of higher expectation of an ‘innovative procedure’”.

Their conclusion is one for all urological surgeons to note.

“We suggest that urologists carefully portray the risks and benefits of new technologies during preoperative counselling to minimise regret and maximise satisfaction.”

In recent years, the treatment of prostate cancer has been a rapidly developing field, providing patients with a  wide range of different cancer care choices .

Brachytherapy and HIFU offer non-surgical options and for those who want surgery, there are open, laparoscopic and nerve-sparring options, depending upon your diagnosis and treatment provider.

At the same time, patients are becoming increasingly proactive, using the internet to research and consider the different  prostate cancer treatment options themselves, as well as the traditional consultation with the urologist.

Increased choice is without doubt a positive benefit for patients, but as urology centres – both private and NHS – seek to attract patients, we have a responsibility to carefully counsel them about the advantages and disadvantages of treatments.
There is a distinctive risk when a procedure is perceived to be new and especially “innovative”. The media will always be interested in the next “pioneering operation”, particularly one which involves robots.

A newspaper article will tend to portray the new procedure as an immaculate solution, which corrects all the risk and disadvantages of other procedures.
As surgeons, we have a responsibility to provide patients with a more sober and informative picture, acknowledging limitations as well as benefits.

The patient satisfaction study was based on the responses of 400 men who had undergone retropubic radical prostatectomy (RRP) or robot-assisted laparoscopic radical prostatectomy between 2000 and 2007 in the US.

The report’s authors also examined patients urinary domain scores, hormonal domain scores and found scores were independently linked with regret.

It is still early days for robotic surgery in the UK. In prostate cancer surgery, there are currently six Da Vinci robotic machines in the UK, compared with 350 in America.

There is no current evidence that robotic surgery provides better outcomes for patients, in terms of urinary symptoms, post operative sexual function or post-operative risks and complications. It seems certain that robotic surgery will increase within the UK during the next decade, with NHS and private centres purchasing the Da Vinci machines.

This will provide even more choice for patients, which is in principle, a positive development.

It is however vital that patients are given accurate and comprehensive information to enable them to make an informed choice, rather than simply being over-sold on a new product.

By: Alan Doherty

Article Directory: http://www.articledashboard.com

Alan Doherty is a Consultant Urologist and Medical Director of The Birmingham Prostate Clinic. A centre of excellence for Prostate Cancer Treatment.

Here are some related posts about prostate cancer treatment options

Prostate Cancer – Causes And Treatment

The treatment options for organ-confined prostate cancer or locally advanced prostate cancer usually include surgery, radiation therapy , hormonal therapy, cryotherapy, combinations of some of these treatments, and watchful waiting. 

Chemotherapy  Treating Prostate Cancer

It is really up to the patient and his doctors to decide whether on balance the advantages outweigh the risks. D.Valerian is a freelance writer interested in items such as prostate cancer treatment 

Preventing Prostate Cancer

In addition, this report discusses the strides made in prostate cancer prevention, and why this cancer in particular should be a target for prevention, rather than treatment. 

Prostate Cancer Treatment Options

Radical prostatectomy is one of the most invasive prostate cancer treatment options. This procedure will remove the prostate and the affected lymph nodes. This is to prevent the spread of cancer cells from reaching other parts 

Prostrate Cancer Awareness Campaign

Many people are now agreed on the need for a broader prostate cancer awareness campaign and images that create more consciousness in the fight against the disease and the against the ignorance about the disease.

New Prostate Cancer Treatment Options Prostate Cancer Support

The most common therapies for prostate cancer are surgical removal of the entire prostate gland, radiation treatment, and hormonal therapy.

Technorati Tags: cancer, care, choices, cure, davinci, diagnosis, non-surgical, options, prostate, prostatectomy, robotic, surgery, treatment, urologist, urology

There are a few  options for treatment once prostate cancer is diagnosed. One option for localized prostate cancer is surgery and here we look at just what such surgery involves.

The normal approach for surgery in the case of localized prostate cancer is to remove the entire prostate gland and surrounding tissue in an operation known as a radical prostatectomy. The operation is usually performed as a retropubic prostatectomy, in which access is achieved through the lower abdomen, or a perineal prostatectomy, in which access is gained through the perineum which lies between the scrotum and the anus.

During a radical prostatectomy the prostate gland is removed, together with the seminal vesicles, the ampullae (the lower sections of the tubes which carry sperm from the testicles to the prostate gland) and some other adjoining tissue.

In addition, that part of the urethra which passes through the prostate gland, as well as the neck of the bladder and a part of the sphincter muscle that controls urine flow is also removed.

From this you will see that a radical prostatectomy is not minor surgery, but is a demanding procedure which generally lasts anywhere from about 2 to 4 hours. It is also an operation which generally requires a stay in hospital of about 3 days followed by 10 days to 2 weeks at home during which time you will need to use a catheter to drain urine.

In the past a radical prostatectomy almost always resulted in impotence, but today improvements in surgical techniques and the introduction of what is known as ‘nerve sparing’ surgery means that an increasing number of men are now spared from impotence. When nerve sparing surgery is performed the two sets nerves and other vessels that run along the side of the prostate gland are carefully preserved in order to retain the erectile function. This technique is unfortunately not suitable in all cases of prostate cancer.

One of the commonest results of prostate surgery is a degree of incontinence. Almost all patients will experience some loss of control following their operation and this can vary from occasionally dribbling to a complete loss of urinary control. Fortunately, some men are suitable for further surgery to ease this problem and it is sometimes possible to surgically implant an artificial urinary sphincter or to use collagen injections to narrow the opening of the bladder.

Some men will also suffer muscle damage during surgery leading to fecal incontinence, which is essentially a problem caused by a reduction in the elasticity of the rectum. This too can be corrected surgically in some cases. Radiation therapy can also sometimes be used to stiffen the rectal muscles.

Of course surgery is just one of the  treatments available for localized prostate cancer today and, while many men favor it because it involves the immediate and complete removal of cancer cells from the body, you should not automatically assume that this is the best treatment for you. Take some time to look at all of your options and discuss each with your physician before coming to any decision.

Find more information on a range of prostate problems and solutions including the therapeutic practice of milking the prostate.

By Donald Saunders

Answers to Your Prostate Cancer Questions

Outcomes after radical prostatectomy, for example, are better when a surgeon has done 250 procedures and is likely doing more than 50 per year. Experience is important. 

The Commonly Performed Nerve Sparing Total Prostatectomy

The Journal of Urology, Volume 181, Issue 3, Pages 1076-1081, March 2009, Authors:Karl-Dietrich Sievert; Jörg Hennenlotter; Ines A. Laible; Bastian Amend; Udo Nagele; Arnulf Stenzl.

Report Regarding Continence And Erectile Function

There are few published reports on changes in continence and erectile function beyond 2 years after radical prostatectomy. A newly published, prospective study has reported on continence and erectile function between 2 and 4 years after

Artificial Urinary Sphincter Versus Male Sling

Early outcomes of the male sling to correct post-prostatectomy incontinence have been promising in select patients. Long-term data are lacking to determine whether the male sling is as effective as the artificial urinary sphincter.

Trial Needed To Compare Prostatectomy, Radiotherapy

Results of an interactive feature on the web site of the New England Journal of Medicine suggest a need for a large, rigorous, decisive head-to-head clinical trial comparing radiotherapy and surgery for the treatment of prostate cancer. 

Disseminated Tumor Cells In Prostate Cancer Patients After Radical

Purpose: Men with apparently localized prostate cancer often relapse years after radical prostatectomy. We sought to determine if epithelial-like cells identified from bone marrow in patients after radical prostatectomy

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