Prostate cancer remains a significant health concern for men worldwide, often necessitating surgical intervention when the cancer is confined to the prostate gland. Surgery, particularly radical prostatectomy, involves the removal of the prostate along with surrounding lymph nodes, and in some cases, the seminal vesicles. This procedure is crucial in reducing the likelihood of cancer recurrence. Recent advancements in surgical techniques, such as robotic-assisted prostatectomy, have revolutionised treatment outcomes. These innovations offer greater precision and minimise damage to surrounding tissues, crucial for preserving urinary and sexual function post-surgery. Coupled with advancements in imaging technologies and targeted therapies, these surgical approaches underscore a personalised treatment paradigm tailored to each patient’s unique condition and needs.

Robotic Prostate Removal

If you have advanced prostate cancer, your doctor may recommend radical prostatectomy (RP). During this surgery, urologists remove your entire prostate gland and surrounding lymph nodes. They also remove the seminal vesicles, which connect to the vas deferens and secrete semen. Your doctor will perform this procedure laparoscopically, which means they’ll make a few small cuts in your abdomen. They’ll then insert a thin rod with a camera at the end (laparoscope) and surgical tools into these incisions to do the operation.

During a robotic prostatectomy, your surgeon will sit at a console to control the robot’s pencil-sized instruments, which have a range of motion more precise than a human wrist. The robot’s magnification and 3-D visualisation allow our urologists to see delicate structures, including nerve bundles, around the prostate and bladder. This allows them to avoid injury to these important structures, which could impair urinary function or sexual functioning after the surgery.

Robotic prostatectomy can be used to treat nearly all patients whose cancer is confined to the prostate. However, in some cases, the doctor may need to switch to conventional laparoscopic or open surgery if a robot-assisted procedure proves unsuccessful. This is rare but possible. Urologists like Dr Marlon Perera are trained in both open and robotic surgery, so they can quickly switch to a different approach if needed.

Precision Radiation Therapy

When prostate cancer has not spread beyond the prostate gland, the most common treatment is to remove the tumor with surgery. This is called a radical prostatectomy. Surgery can be used in combination with other treatments, including hormone therapy and radiation.

For patients with localised prostate cancer that hasn’t spread, surgeons can use techniques to reduce the amount of radiation they give their patients. For example, IMRT allows doctors to vary the intensity of each radiation beam, which means they can better target cancer cells while sparing nearby tissue.

MRI can also be used to identify and help guide surgical options. This type of imaging can help to spot larger cancers that may be hidden by the penis or other tissue, and it can also reveal the extent of a tumor’s growth or spread.

For some men with advanced disease, surgery is not an option. This is because the cancer has likely spread to other parts of the body, such as the lymph nodes and bones. However, a new type of treatment can now control this cancer for long periods of time and improve the quality of a man’s life. This treatment involves the use of a radioactive drug that targets PSMA-expressing cancer cells while leaving surrounding tissue undisturbed. It is called lutetium-177-PSMA-617, and it is now available to treat patients with metastatic prostate cancer who have become resistant to ADT.

Personalised Treatment for Understaging

If your cancer hasn’t spread outside the prostate gland, prostate cancer surgery Melbourne may cure it. The main type of surgery is called a radical prostatectomy. This involves making a long cut into your tummy (abdomen). Your surgeon will take out the prostate and some tissue around it, including the seminal vesicles and nearby lymph nodes. Your surgeon might try to avoid injuring the nerves that control erections, which is known as a nerve-sparing approach. This can help prevent side effects like erectile problems and urinary incontinence.

Advances in multiparametric MRI can also improve treatment. These types of MRI scans can help doctors look at how the tissues around the prostate might be affected by radiation. They can also help your doctor decide how much of the prostate to remove.

A new surgery called focal therapy can be used to treat the parts of the prostate that have cancer in them. This reduces the risk of your cancer coming back and helps you avoid the side effects that might be caused by having the whole prostate removed (eg, erectile dysfunction and urinary incontinence).

Recent studies have shown that ADT can control metastatic disease, which is when the cancer has spread to other parts of the body. A combination of ADT and the drug darolutamide or abiraterone improves outcomes in these patients over ADT alone.

Postponing Treatment

Whether out of fear, concern about the cost, or a desire to avoid complications, some prostate cancer patients have postponed surgery. However, delaying treatment can lead to worse outcomes.

The most common treatment for prostate cancer is the removal of the entire gland, a procedure known as radical prostatectomy. It is best performed in high-volume medical centers by doctors who routinely perform it. Depending on your risk, you may be able to choose between several surgical techniques.

During surgery, your surgeon might remove some of the lymph nodes that surround your prostate. These are sent to the lab to be looked at for cancer cells. If the nodes do contain cancer, your surgeon can use this information to reduce the chance of your tumor coming back in the future. Your doctor might also use this information to recommend other types of treatment.

After surgery, some men experience bladder leakage or dribbling, which can be bothersome and affect their quality of life. In many cases, however, this is a temporary condition that improves with time. Some men also lose potency, though this is less common.

Some people with advanced cancer get a better response to treatment when their testosterone levels are lowered with drugs (called androgen deprivation therapy, or ADT). This can prolong survival. However, some patients develop resistance to ADT, which is why a variety of options are available for treatment.

Innovations in Prostate Cancer Surgery

The evolution of surgical techniques for prostate cancer, including robotic-assisted procedures and precision therapies, marks a significant stride towards improved patient outcomes. These advancements not only enhance surgical precision and recovery but also contribute to better long-term quality of life for patients. As research continues to drive innovation in the field, patients and healthcare providers alike can explore these cutting-edge options for comprehensive care and treatment solutions.