Robotic surgery: A breakthrough in prostate cancer treatment for younger patients

Dear Dr G,

I am delighted to learn you have dedicated this November to Prostate Cancer Awareness.

I recently went for a routine medical check-up at the age of 55.

The cancer marker was elevated, leading to a biopsy that unfortunately detected prostate cancer.

I was devastated by the diagnosis; however, I understand that, like the Prime Minister of Singapore, Lee Hsien Loong, I need to build up the courage to beat cancer.

I suppose I am fortunate, as the tests showed an intermediate early-stage cancer.

As I am considered young, the urologist recommended surgery with the aim of a cure.

The surgeon explained that I might encounter problems such as erectile dysfunction and urinary incontinence after the procedure.

Although I am prepared to face the worst, I am still holding on to some hope that I can preserve my urinary continence, erectile function, and fertility.

I hear that my hope lies with the assistance of robotic surgery, and therefore, I would like to ask Dr G for some insights.

Can you tell me why I have prostate cancer at such a young age?

Why does the operation for prostate cancer result in incontinence and impotence?

How can robotic surgery help minimise these complications?

Apart from robotic surgery, are there any other treatment modalities suitable for me?

Thank you in advance.

Yours truly,

Robotic Robert

The diagnosis of prostate cancer is on the rise in many countries. Many experts attribute this increase to the common use of the prostate cancer marker diagnostic test, PSA (Prostate-Specific Antigen). Others believe the rise may be linked to genetic mutations in men with a family history and the overall increasing life expectancy in men.

Although the cancer is generally associated with older men, detection in younger men is becoming more common. This trend is thought to be linked to genetic factors and a sedentary lifestyle. Prostate cancer is becoming so prevalent that it can affect up to one in six men in many high-income nations. One of the most common methods for complete eradication of stage I prostate cancer is radical prostatectomy.

Such surgical procedures can be performed using open or keyhole approaches. In recent years, cutting-edge robotic-assisted removal of the prostate gland has been utilised to minimise complications. However, the anatomical location of the prostate is closely associated with the nerves and blood supply to the penis. Therefore, any intervention on the prostate gland often adversely affects men’s sexual and reproductive health.

Before undergoing radical prostatectomy, most men are counselled about potential complications such as urinary incontinence, erectile dysfunction, and sterility.

Although meticulous intra-operative care is taken to preserve the nerves responsible for continence and erections, neurovascular preservation is only possible with modern medical technology if the malignancy is diagnosed at an early stage.

The advantages of robotic laparoscopic techniques allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times and fewer complications. The advanced robotic systems provide 3D vision and surgical field magnification up to 15 times, enhancing the surgeon’s ability to recognise and control small blood vessels.

Due to robotic technology, surgeons can perform minimally invasive procedures with greater precision. Robotic arms remain steady at all times, and robotic wrists make it easier for surgeons to manipulate tissue and work from various angles, positions otherwise difficult to reach.

Patients may not be suitable for Robotic Radical Prostatectomy for various reasons, including costs, availability of facilities, or fear of the operation. Other curative treatment modalities for prostate cancer include external beam radiation or brachytherapy.

Patients opting for these interventions may experience fewer complications such as urinary incontinence, bleeding, or operative issues. However, radiation-induced complications like frequency, urgency, and urge incontinence of urine may arise instead.

The diagnosis of cancer is often unexpected and frightening, and the journey of treatment and recovery may be plagued with disappointing outcomes. Recent advancements in space-age technology, such as robotic surgery, have helped many men overcome their fears and achieve a cure with desirable outcomes.

Jamais Cascio, a research fellow at the Institute for the Future and a famous San Francisco-based author, once said: “Resilience is all about being able to overcome the unexpected. Sustainability is about survival.”

Many men suffering from prostate cancer who contemplate robotic surgery often seek Dr G’s opinion. His view is: “The unexpected diagnosis of prostate cancer begins with a journey of resilience; robotic surgery is often the helping hand to ensure sustainability of survival with minimal compromises in sexual health.”