Surgery for Prostate Cancer

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Is Prostate Surgery Right for Me?

Choosing surgery for prostate cancer depends on several key factors, including your stage of prostate cancer and overall medical condition.

Physicians at Fox Chase recommend the best surgical approach for each patient and discuss all treatment options with patients.

Robert G. Uzzo, MD, FACS

Robert G. Uzzo, MD, FACS,
Co-Leader, Genitourinary Cancer Program;
Chairman, Department of Surgery; Attending Surgeon, Urologic Oncology; G. Willing "Wing" Pepper Chair in Cancer Research;

Surgery for prostate cancer allows the complete removal of the cancer with preservation of unaffected normal tissue. Each of our highly skilled surgeons is experienced in tissue-sparing methods to cure the prostate cancer while preserving long-term urinary and sexual functions.

Surgery is tailored to each patient's specific situation. The best candidates for nerve-sparing prostate surgery are men with localized tumors; a PSA level of 10 or less; a Gleason score of 7 or less; and no prior use of erectile dysfunction drugs.

Following surgery, world-class pathologists at Fox Chase assess the prostate tissue and pelvic lymph nodes, allowing them to more accurately assess prostate cancer staging. This additional information can help physicians determine the prognosis and direct the need for additional therapies such as chemotherapy or hormone therapy.

Robotic and Open Surgical Approaches Give You
More Treatment Options

Fox Chase's highly-skilled surgeons specialize in robotic-assisted laparoscopic (da Vinci®) and conventional "open" nerve-sparing radical prostatectomy for prostate cancer treatment. Fox Chase is home to the region's dominant oncologic robotic surgery program.

Robotic-assisted Laparoscopic Prostatectomy
(Minimally Invasive Surgery)

Robotic-assisted laparoscopic (da Vinci) surgery offers the latest surgical advance in the treatment of prostate cancer. This technique offers similar or better outcomes when compared with conventional open surgery, and has additional benefits. While its technological advantages are significant, your surgeon's skill and experience remain the most important elements for achieving superior surgical outcomes.

Introducing the newest generation in robotic surgery technology: da Vinci S
While its technological advantages are significant, your surgeon's skill and experience remain the most important elements for achieving superior surgical outcomes. More

Robotic-assisted surgery is a form of laparoscopic surgery. Fox Chase surgeons utilize the second generation da Vinci® S robotic surgical system, the newest and most advanced minimally invasive surgical instrument available today. Fox Chase Cancer Center is at the forefront with this approach and is the only hospital in the Delaware Valley that offers the da Vinci S surgical system for prostate cancer treatment.

How is Robotic Surgery for Prostate Cancer Performed?

During robotic prostate surgery, surgeons make six half-inch long incisions in the patient's lower abdomen through which a small camera and specialized surgical instruments are inserted. The camera allows the surgeon to see the prostate and surrounding structures at 10x magnification. This minimally invasive surgical approach replicates the open surgical procedure, while avoiding the traditional incision needed to expose and remove the prostate.

On completion of the operation, the surgeon removes the prostate and surrounding pelvic lymph nodes through the small openings. Because this is a comparatively blood-less surgery, the surgeon has a pristine view of the prostate and the vital surrounding structures, allowing unparalleled surgical precision and results.

What are the benefits to patients of robotic-assisted prostate cancer surgery?

While robotic-assisted laparoscopic prostatectomy is more technically demanding than conventional "open" surgery and may take longer, there are many potential benefits to patients, including:

  • Significantly less bleeding
  • Less pain
  • Less fluid build-up
  • Shorter hospital stay
  • Fewer days with a urinary catheter
  • Less interruption to bladder and bowel functions
  • Quicker recovery
  • Earlier return to normal activity

Not all patients are appropriate candidates for minimally invasive prostate surgery. It is generally best suited for men under the age of 70, with a low to intermediate grade prostate cancer, who have not had prior pelvic radiation or surgery.

"Open" Surgery

The best results from surgery for prostate cancer have been established with a traditional "open" surgical approach.

Surgeons at Fox Chase have extensive experience performing nerve-sparing radical retropubic prostatectomy using an "open" surgical approach.

In this procedure, an incision is made between the navel and pubic bone. The surgeon removes the prostate and surrounding pelvic lymph nodes. Retropubic prostatectomy provides the best chance of sparing the urethra (tube that carries urine) to preserve the ability to urinate normally. This procedure is commonly performed with preservation of the nerves and blood vessels responsible for normal erection of the penis. Treatments that remove or damage these nerves can result in erectile dysfunction, also known as impotence. Open surgery generally takes 2.5 to 3 hours if nerves are not spared; 3.5 to 4 hours if nerves are spared.

 

Additional Surgical Considerations for Prostate Cancer

Patients with Advanced or "High-Risk" Prostate Cancer

At Fox Chase Cancer Center, men with advanced, or high-risk, prostate cancers, who are candidates for surgery, may be eligible to participate in clinical studies involving hormone therapy or chemotherapy. Patients with advanced or metastatic prostate cancer may participate in clinical trials using a combination of hormonal therapies and radiation therapy.

Hormone Therapy in Addition to Surgery

For larger or more aggressive tumors, hormone therapy in addition to surgery may be recommended because of the high risk that the cancer has spread outside the prostate.

Prostate Cancer Recurrence

In select circumstances, Fox Chase surgeons offer options for men whose prostate cancer has recurred (come back) after initial treatment with radiation therapy has failed to eradicate the cancer.

  • Salvage prostate cryoablation - Cryoablation, also called cryotherapy or cryosurgery, is a procedure that kills the cancer by freezing the cells with a small metal tool placed in the tumor.
  • Salvage radical prostatectomy - Removal of the prostate after the cancer has not responded to other treatments. This procedure generally offers better outcomes over cryoablation.

[5/7/2014]

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