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Robotic Prostatectomy Archive Questions

Below are Dr. Borin’s answers to Robotic Prostatectomy questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 57.

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Q : 1

Hello, My father is the patient here. His last PSA reading shows 12.80. He has done his biopsy twice before and the result shows absence of cancerous cells. Our doctor says its benign hypersia and has suggested cystoscopy. During the procedure, as stated by the doctor, if any blockage is found due to expansion of prostate gland they would resort to TURP. My question is if prostate is partially removed and examined to find cancerous would it be possible to go for robotic prostactomy after that or what would you suggest given the scenario?

A prostatectomy (either robotic or open) can be performed after a TURP, but it is more difficult. A TURP is only done if the patient is having symptoms. Treatment options depend on the patient's age, symptoms, and other medical conditions--there is no "one-size-fits-all" answer

Q : 2

I've had an enlarged prostate for quite some time. Stream flow is very weak but my main issue is sleep interruption several times a night. I would like to have the minimally invasive surgery to correct this. Is it a permanent fix?

Medications are usually the first step. If those fail, then there are several different minimally invasive procedures that can reduce the size of the prostate. Surgery greatly improves symptoms, but the prostate can regrow over the course of about 10 years.

Q : 3

I am 84 years old, active and healthy but I was just diagnosed with an aggressive form of prostate cancer. Do you feel that a robotic prostatectomy would be a better treatment than radiation and hormone therapy?

Surgery for prostate cancer in men above age 80 is very rarely performed. The risks are higher and urinary leakage seems to be more of a problem. I think most urologists, including myself, would recommend radiation. Cure rates are similar to surgery and there is less risk to you.

Q : 4

Do provide second opinions on a diagnosis of prostate cancer?

The majority of my patients have been diagnosed by another physician and come to me either for a second opinion or with the intention of transferring their care to me. I am happy to give advice based on the data available (PSA, prostate ultrasound report, CT/MRI/bone scan, biopsy report) and I generally do not need to do another biopsy. I do request that you obtain the biopsy slides so they can be reviewed by our pathologists. It is ideal to have this done well in advance of your visit, but it is not critical.

Q : 5

I have decided to removed my enlarged prostate (83cc) which has multiple areas of hemorrhage, atrophy and scarring from previous biopsies (2005,2006) and one focal cryoablation (2006). I also have hematuria and prostatitis. Am I a candidate for robotic or is open surgery a better option?

Any surgery after a cryo treatment is potentially more difficult. You should be thoroughly evaluated and discuss the risks and options with your surgeon.

Q : 6

Would I be a candidate for robotic prostatectomy if my prostate is 90 cc in size?

Prostate size above 70 cc can make the procedure a bit more complicated for inexperienced surgeons. If you are otherwise a surgical candidate, then a size of 90 cc would not be a problem for me or another experienced robotic surgeon.

Q : 7

On average, does the therapeutic benefit of Flomax increase over time, or does the benefit plateau within three months or so? I've been taking 4 mg of Flomax for seven or eight weeks. It only started working at week six.

Flomax works very quickly and symptoms usually improve within the first week. I usually wait three months to determine whether it is helpful. make sure you are taking it correctly: 30 minutes after the same meal each day.

Q : 8

How effective is the robot-assisted laparoscopic prostatectomy?

This is a difficult question to answer. The three outcomes we look at are cancer control, return of continence, and erectile function. For the most part, anyone who is a candidate for open radical prostatectomy will also be a candidate for robot prostatectomy. Results are similar between the two procedures but there may be less blood loss, shorter recovery, and fewer strictures with robotics.

Q : 9

Does the bladder neck sphincter have to be removed during the da Vinci Robot radical prostatectomy? Won't this cause incontinence?

The bladder neck is disrupted during radical prostatectomy in both the da Vinci and standard open prostatectomy. This is one of several factors which contribute to the incontinence that some men experience. Other factors include prostate size, patient age, pre-operative symptoms, etc. Surgeons who perform radical prostatectomy, both open and da Vinci, should counsel their patients on the potential risks of short-term and long-term post-operative incontinence.

Q : 10

How many robotic prostate surgeries should a urologist do to achieve minimal competency?

This is very dependent on a surgeon's training and prior experience. Some studies show that minimal proficiency can be achieved after about 20 cases, but results continue to improve even after 200 cases.

Q : 11

I am 53 years old and have been diagnosed with prostate cancer. My PSA is 5.7 and Gleason is 6. Do you think a prostatectomy is the best choice of treatment for me?

Your options include active surveillance, surgery, and radiation. The specific choice of treatment depends on a dozen different factors which would be discussed during a consultation. In general, young healthy men who want active treatment are good candidates for prostatectomy.

Q : 12

I had the surgery a week ago, is discoloration of the penis and sack normal? There isn't any pain, just the discoloration.

Some discoloration is normal and should resolve over a week or two. Make sure to show it to your surgeon when the foley catheter is removed. If it gets worse or becomes red or painful, you should seek medical attention. Usually it's just some bruising that fades over time.

Q : 13

What is recommended treatment for prostate cancer that has only spread to the lymph nodes?

Hormones are generally the mainstay of treatment for prostate cancer that has spread to the lymph nodes. If the prostate has not been removed, then hormones with or without external beam radiation are recommended. If the prostate has already been removed, then observation or hormone therapy is indicated.

Q : 14

What is the percentage of incontinence for open surgery, robotic surgery, and hormone and radiation therapy?

Age, prostate size, current symptoms, prior surgery, and other medical conditions are the most important factors in determining what your continence will be after surgery. In general, 5-10 percent of men will have significant incontinence requiring 2 or more pads per day 1 year after surgery, whether open or robotic. Another 10 percent will have mild leakage. In some cases, continence may return earlier after a robotic procedure, but overall continence rates seem to be similar. The risk of a stricture is lower after a robotic procedure. Incontinence rates are lower after radiation (less than 5 percent), but the risk of urinary bother is much higher.

Q : 15

What is the recovery time after surgery?

Usually the procedure requires a 1 or 2 night stay in the hospital. The catheter is removed after about a week and patients can go back to work in about 2-3 weeks. I allow my patients to begin resuming full physical activities after 4 weeks.

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