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While the number of prostate cancer cases has been increasing in recent years, the number of deaths due to this form of cancer has seen a decline. The success in treating prostate cancer is primarily due to the use of the prostate specific antigen (PSA) test that helps to detect prostate cancer at an early stage. Early diagnosis leads to early treatment with an improved prognosis.

In the treatment of prostate cancer, it has been found that radical prostatectomy, which involves the surgical removal of the prostate gland, is a far superior alternative to watchful waiting since it reduces significantly the risk of the cancer spreading.

Radical prostatectomy allows the doctor to determine the exact stage of the cancer based on a pathological examination of the excised mass. Another advantage is that the surgery's success can be easily gauged within a few weeks based on the PSA test.

A radical prostatectomy can be performed by one of two methods.

• Open prostatectomy - This is the traditional form of surgery for removing the prostate. It involves making an incision from the navel to the pubic bone which allows the surgeon access to the diseased tissue. The procedure involves significantly greater blood loss and a longer, more painful convalescent period. The risk of complications is also much higher.
• Laparoscopic prostatectomy - This is a less invasive form of treatment involving several small incisions made into the abdomen. The advantages of this procedure lie in the fact that there is significantly less loss of blood owing to the smaller incisions. This translates into a speedier recovery with lower risk of complications.

In robotic radical prostatectomy, the surgeon uses a computer controlled robot to perform the surgery. The advantages of this method over traditional laparoscopic techniques include:

• Advanced Optics - The advanced optics allow for a much better three dimensional view of the prostate and the surrounding tissue. This translates into greater precision and helps to preserve healthy tissue.
• Elimination of Tremors - The robotic arms eliminate even the slightest tremors allowing for much greater precision.
• Greater Maneuverability - The "wrists" of the robotic arm can pivot up to 540 degrees, allowing for much better flexibility and maneuverability when compared to traditional laparoscopic instruments.

Procedure

The surgeon sits at the computerized console which controls the robotic arms. The robotic arms contain miniaturized cameras and specialized instruments mounted on them. These are inserted into the patient's abdomen via four small incisions. The movements of the surgeon's wrists and fingers are translated by the robot into extremely precise micro-movements. The precision is of such a degree that the surgeon can avoid damage to the surrounding nerves that control functions such as urinary continence and sexual function.

Following the surgery, patients are monitored for a day and usually sent home on the following day. Most patients can resume their full range of normal activities within a couple of weeks.

Benefits

The benefits of this procedure include:

• Smaller incisions which mean less scarring
• Quicker recovery which means a shorter hospital stay
• Less pain
• Less blood loss and need for blood transfusions
• Lesser chance of complications after the surgery such as urinary incontinence
• Lesser chance of post surgical infection
• Quicker return to normal activities

Prognosis

Studies conducted on patients who have undergone robotic radical prostatectomy show that the success rate in controlling localized prostate cancer is as good, if not better than open or laparoscopic procedures. Some studies indicate that robotic radical prostatectomy allows for an earlier return to continence and potency.

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