Download Laparoscopic radical prostatectomy

Prostate Cancer Treatment
There are various treatments for prostate cancer. The treatment that's best for each man
depends on several factors. These include how fast your cancer is growing, how much it has
spread, your age and life expectancy, as well as the benefits and the potential side effects of the
treatment. The most common treatments for prostate cancer include the following:
Surgery (Radical prostatectomy)
Radioactive seed implants (Brachytherapy)
Surgery (Radical prostatectomy)
Surgical removal of your prostate gland, called radical prostatectomy, is used to treat cancer
that's confined to the prostate gland. During this procedure, your surgeon completely removes
your prostate and nearby lymph nodes, if necessary. The advantage of this operation is that the
tumour (and prostate) is removed from the body which patients often find more reassuring than
treatments that are done by leaving the prostate in the patient.

Open radical prostatectomy: This method certainly has
been the gold standard until recent years. Its results have set very
high standards in terms of cancer control, continence and nerve
sparing in the best units. However , the laparoscopic and robotic
approaches have shown in numerous studies that they are
undoubtedly equivalent in outcomes and in most series have lower
positive margin rates as well as better continence and potency
rates.

Laparoscopic radical prostatectomy: this technique was pioneered in the
1990's in France and set the benchmark for minimally invasive radical prostatectomy. The
operation is extremely difficult to perform because in laparoscopy for all surgical areas the
instruments are long, rigid and movements are counterintuitive. ( a bit like shaving left
handed in a mirror!) There is little doubt that in very skilled hands there is very little
difference between laparoscopic radical prostatectomy and robotic assisted laparoscopic
radical prostatectomy.
In learning the pure laparoscopic method the surgeon has to considerably more cases
than the robotic surgeon to achieve the equivalent level of competence. Hence there has
been widespread and rapid development of robotic surgery whereas laparoscopic radical
prostatectomy is performed by a select few.
Robotic surgery has gained huge popularity in the USA and to date more than 60% radical
prostatectomies are done robotically. In Europe laparoscopy is still very popular but
robotics is gaining in popularity .In the UK more than 90% of radical prostatectomies are
done by open surgery .This is mainly driven by a lack of acceptance of the inevitable
development of minimally invasive techniques .In short, most urologists in the UK don't
have the requisite skills to do radical prostatectomy in any way other than by the open
method.

Robot-assisted laparoscopic radical prostatectomy (RALRP):
The development of Robotic Assisted Laparoscopic Prostatectomy has transformed the
traditional thinking and approach to surgery of the prostate. It has given surgeons a
minimally invasive way to perform the same maneuvers that they did with their hands in
the open operation. Movements are fully intuitive, instruments are articulated, and the
vision is extremely magnified and projected in 3D. For further description please refer to
section on robotic surgery.
Side effects of radical prostatectomy can include:


Bladder control problems (urinary incontinence). With laparoscopic or robotic
prostatectomy you are expected to have minimal urinary leak and indeed many patients
are dry from the time the catheter is removed. However if some incontinence is present
these symptoms can last for weeks or even months, but most men eventually regain
bladder control. Often the incontinence is "stress incontinence", meaning they're unable to
hold urine flow when their bladders are under increased pressure.
Erectile dysfunction. The nerves that supply the penis to achieve erection are attached to
the sides of the prostate and therefore can be damaged during the prostate removal. With
the enhanced visibility and magnification in the sparing of these nerves is improved and
in good hands results of maintaining potency are excellent. Most men younger than age
50 who have nerve-sparing surgery are able to achieve spontaneous erections afterward,
and even some men in their 70s are able to maintain normal sexual functioning. Men who
had trouble achieving or maintaining an erection before surgery have a higher risk of
being impotent after the surgery.
Radioactive seed implants ( Brachytherapy)
Radioactive seeds implanted into the prostate have gained popularity in recent years as a
treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose
of radiation than do external beams, but over a substantially longer period of time. The therapy
is generally used in men with smaller or moderate-sized prostates with small and lower grade
cancers.
During the procedure, between 40 and 100 rice-sized radioactive seeds are placed in your
prostate through ultrasound-guided needles. The implant procedure typically lasts one to two
hours and is done under general anesthesia Most men can go home the day of the procedure.
Sometimes, hormone therapy is used for a few months to shrink the size of the prostate before
seeds are implanted. The seeds may contain one of several radioactive isotopes - including
iodine and palladium. These seeds don't have to be removed after they stop emitting radiation.
Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond
their location. This type of radiation isn't likely to escape your body in significant doses.
However, doctors recommend that for the first few months you stay at least six feet (1.83
meters) away from children and pregnant women, who are especially sensitive to radiation. All
radiation inside the pellets is generally exhausted within a year.
Side effects of radioactive seed implants can include:

Urinary problems. The procedure causes urinary signs and symptoms such as frequent,
slow and painful urination in nearly all men. You may require medication to treat these
signs and symptoms. Some men need medications or the use of intermittent selfcatheterization to help them urinate. Urinary symptoms tend to be more severe and
longer lasting with seed implants than with external beam radiation.

Sexual problems. Some men experience erectile dysfunction due to radioactive seed
implants.

Rectal symptoms. Sometimes this treatment causes loose stools, discomfort during bowel
movements or other rectal symptoms. However, rectal symptoms from radioactive seed
implants are generally less severe than with external beam radiation.