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 34.

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Q : 1 09/07/2009	What is the data for incontinence with Da Vinci robotic prostate removal surgery? What percentage of patients are incontinent after surgery immediately, at 1 month, 2 months, 3 months, 6 months? Are there any bowel problems (incontinence, constipation, diarrhea, etc.)? In general, continence will return to 10% of men within 1 week of catheter removal, 50% within 3 months, and 80% within 6 months. Some surgeons may have better numbers. Bowel irritation or stool incontinence is pretty rare, usually affecting <8% or so.
Q : 2 06/28/2009	I have early stage prostate cancer, T2 Gleason score of 3+3=6. How do the side-effects of robotic laproscopic surgery compare with external beam radiation (IMRT) in terms of impotence and incontinence? Much of this will depend on your age and pre-operative urinary and sexual function, as well as the size of the prostate. In general, surgery provides an earlier diagnosis, and definitive cure can be assessed within a few months. There is more urinary leakage with surgery, but less bothersome symptoms. If a nerve-sparing operation is performed, then erectile function may be slightly better preserved as compared to external beam. Brachytherapy may be slightly better in terms of erectile function preservation. Also, radiation can cause bowel irritation in a small subset of patients, while this is rare for surgery.
Q : 3 05/21/2009	If cancer is detected in all 6 sections of the prostate, is there any additional risk of cancer cells leaking or spreading due to "squeezing" the prostate when it is extracted (through the small incision) using the robotic laproscopic technique as opposed to open surgery? Is open surgery sometimes preferred in such a situation? During robotic and laparoscopic surgery, the prostate is put in a specially designed plastic bag before it is removed so that it does not touch the skin. There should be no increased risk of the cancer spreading based on the technique used to take it out. The best chance of cure is by removing all of the cancer with a negative margin, and there is some evidence that robotic surgery has a better chance of achieving this than open surgery. In most cases, it is the skill of the surgeon and not the technique that is important.
Q : 4 03/05/2009	My brother was recently diagnosed with prostate cancer. Eleven of the 12 tissue specimens were found to be cancerous and the Gleason Scale scores were 9s. He is 77 years old and in very good health. He was advised not to undergo surgery, rather to have radiation and hormonal treatment. I recently read an article that indicated a significantly better 10-year survival rate for surgery over radiation, with younger men and those with aggressive cancers (like my brother's) benefiting. Do you think there would be an advantage to having surgery in my brother's case? There is no definitive evidence one way or another. Surgery or radiation alone are probably not enough. We have had very good success in patients with similar disease using external beam radiation, hormones, and brachytherapy. If he does have surgery, there is a good chance that he will need radiation afterward. Other factors such as PSA and rectal exam will also help his urologist decide. Men in their 70s who are healthy usually tolerate the surgery well, but the recovery can take a while, particularly recovery of continence.
Q : 5 01/28/2009	I'm 47 years old and have diagnosed with early prostate cancer. I would like to know more about robotic surgery, could it help me? Robotic Prostatectomy is the newest and most technologically advanced method to remove the prostate. It has all the benefits of removing the prostate just like the open procedure, but the recovery time is faster and there is less blood loss. Six small incisions are made (about the size of a dime) and the prostate is removed through a 1.5 inch incision above the belly button. I'd be happy to evaluate you as a candidate for the procedure. You can call my assistant, Leeanna, to make an appointment: 410-328-6422
Q : 6 01/07/2009	Is it common to have to catheterize yourself after having prostate surgery or TURP? Before surgery I had minimal problems with urination, but my prostate was very large. I now have no sensation for urination and my doctor told me that my bladder has stretched and that I will have to catheterize myself for the rest of my life. It is difficult to tell what may be wrong with your bladder. Usually, if your bladder is so stretched out that it does not work properly, it is because of something that was going on for many years. Sometimes men do not realize that they have bladder problems and only experience minimal symptoms. This is due to the prostate causing a severe blockage. The other possibility is that there is prostate tissue left over from the surgery that is causing a blockage. Tests such as urodynamics and/or cystoscopy can be used to diagnose your problem.
Q : 7 12/26/2008	How soon can I expect some bladder control following prostate removal surgery? Hopefully your doctor discussed his usual results with you, as it can vary from surgeon to surgeon. This process can take several weeks to several months, even up to a year. Most men will start regaining control within 3-6 months. Do your Kegel exercises 3 times a day. They will help.
Q : 8 05/21/2008	My friend has been diagnosed with a T2a, Gleeson score 7 prostate cancer. He has also had recent weight loss of about 15 lbs. He has been told he will have to wait at least 2 months after his biopsy for surgery. Does it make sense to wait so long an interval without at least investigating the possibility of M1 status in the interim? Would it not be helpful to get a pelvic CT or even a PET scan to rule out mets before surgery? Would there be any way to expidite a second opinion at UMGCC? There have been several studies looking at delay between diagosis and surgery/treatment, and they generally show no detriment in waiting 3 months, so I would not worry too much about that. With the old style open surgery, there seemed to be a greater risk of rectal injury if the surgery was done too soon after biopsy (usuually <6 weeks). With robotic surgery, we generally only have to wait 2 weeks. Indications for CT or bone scan are mostly based on the PSA, usually greater than 10 or 20. We use nomograms to help determine the risk of metastatic disease and then get appropriate imaging. One of the things we have been doing here is to get endorectal MRI to help quantify the location and extent of the cancer. It can also substitute for the pelvic CT because it can detect abnormal lymph nodes. Not sure what to make of the weight loss; ususally early prostate cancer won't cause that. If there is no other reason for it, I'd consider a more thorough work-up. I'd be happy to see him and offer a second opinion.
Q : 9 04/07/2008	What is your opinion concerning shrinking the prostate? There are 2 drugs on the market which will cause the prostate to shrink over the course of 6-12 months. They are used for men who have an enlarged prostate that is causing moderate to severe symptoms, blocking the flow of urine. Many studies have shown that these drugs can be very effective in the proper patients.
Q : 10 04/03/2008	I read your Q & A Archive. There was no mention of damage to the blood vessel that controls erection. What would be the cause of damage to these blood vessels during the robotic operation? During any surgery for prostate cancer, whether robotic or traditional open, the nerves that control erections will be damaged to a certain extent. This is because these nerves are right next to the prostate and must be dissected away from it. The blood vessels that carry blood to the penis are usually not damaged.
Q : 11 03/21/2008	A friend of mine is considering robotic surgery. His complicating issues are: (1) he apparently has a very much enlarged prostate, (2) he is overweight by 30-40 pounds, (3) he was treated for prostate cancer with hormones 2-3 years ago. His PSA went down following the treatment and he thought his cancer had gone into "remission." His PSA has gone up and his biopsy shows a gleason score of 6. I assume he is still a candidate for a robotic procedure but what would be the concerns/potential complications given the above points. Any other advice is welcomed. Unfortunately, hormones do not cure prostate cancer; they only slow the growth. It will be important to find out why he wasn't offered curative therapy several years ago -- if there were reasons that he couldn't or shouldn't have surgery then, those reasons may still be valid today. A large prostate and an overweight patient may make the surgery a little more difficult and may result in a delay in return of continence. Prior treatment with hormones shouldn't make much of a difference. The most important factors are his age, general health, PSA level, and number of individual biopsy specimens showing cancer. These will help determine if he needs treatment or can be continued on an active surveillance protocol.
Q : 12 06/25/2007	I recently had robot-assisted radical prostatectomy (RARP); however after the Pathology report, we found out I had positive margins and Extra Capsular Extension. What are my options from here? Further treatment will depend on the grade of the cancer, your post-op PSA, your overall health and outlook. There is some new evidence that early radiation will reduce the chances of disease recurrence. There are also those who believe in waiting for the PSA to rise before initiating therapy. Hormones may be another option. There is a clinical trial that is run by Dr. Richard Alexander here involving the use of a cancer vaccine. I'm not sure what the eligibility criteria are, but you can find out if you are eligible.
Q : 13 06/23/2007	Is the "capsule" removed along with the prostate? Is the prostatic fascia also removed? Yes, the capsule is removed. The outer portion of the prostate, or capsule, is usually where the cancer resides. The inner portion can harbor cancer as well, so the entire gland is removed. There are several layers of fascia covering the prostate, and these layers will also surround the nerves that control erections. Depending on the amount of cancer, some of the fascia will be either removed or left behind. In a nerve-sparing operation, less fascia will be removed with the prostate, so that the nerves are not damaged during dissection.
Q : 14 05/17/2007	I am a very healthy 46-year-old. Since my father had prostate cancer, I started PSA tests at 40. My PSA jumped from 2.25 to 3.25 this past year. I had a prostate biopsy. The results were that 9 cores were clean with one core 20% cancer Stage I, not aggressive. My Gleason Score was 6. No one seems to think I am a candidate to wait and watch my PSA to see if it increases. I still do not understand why, if I have such a low grade, slow growing cancer. There are protocols for surveillance for people with a low PSA and 1 or 2 cores of Gleason 6. However, these require close surveillance with yearly biopsies, and there is no guarantee that the cancer won't progress to the point where it is uncurable. Most people don't recommend surveillance to men under age 65. I agree that a robotic prostatectomy is a very good choice.
Q : 15 05/10/2007	I had robotic prostate surgery in July 06 with an outcome which showed positive margins and some nerve invasion. Gleason of 4+3, staging T2c. My PSA since then has been 0.1. A radiation oncologist wants me to have radiation therapy, while my surgeon is comfortable waiting and if PSA rises, then radiation. My post-surgery recovery has been so good that I am unsure whether to risk complications or radiation based on such a low PSA. What is your opinion? There is no right answer to this question. There are several studies which are looking at this, but there are no definitive answers. With early radiation, the risk of disease recurrence is lower, but there are side effects. There is also a high probability that the disease won't recur even without radiation. If you are having trouble deciding, it may be worthwhile to get all your records together and seek a 2nd opinion from another surgeon who does robotic prostatectomy in your area. He may have several patients like you and could offer another perspective.

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