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Prostate cancer treatment

The incidence of prostate cancer is much less in India than in western world. Unfortunately, due to lack of awareness, the prostate cancer is detected when it is already beyond cure. With the routine use of PSA in man over 50 years, we are picking up early cancer and offer them curative treatment by robotic operation.

The diagnosis :- Prostate cancer has no specific symptoms. The best way is to get PSA test once a year. If it is high in relation to age and volume of prostate, and/or on physical examination prostate feel more firm that normal, a trucut biopsy is taken by the urologist.

 
Usually two reports are desirable especially if there is UTI or Diabetes, where PSA may be falsely high.This generally is able to diagnose the disease. When symptoms start, usually the cancer is already advanced.Biopsy report confirms the presence of cancer and its aggressiveness is assessed by Gleason score which can be from 2-10. Score of 8-10 is very aggressive.

 
The treatment depends upon the stage of cancer and life expectancy of the patient if he did not have the cancer.

If the cancer is limited to the prostate (T1 and T2), the best treatment is radical surgery by open/laparoscopic or preferrably robotic method. If the patient is not fit for operation, he can be treated by ratiotherapy which is nearly as good as surgery. Radiotherapy is the only choice when cancer has come out of prostate but is still within surrounding area (T3). There is evidence that surgery may improve the quality of life even in this group but is not established. Once the cancer has reached the distant area like lymph nodes or bones, the only treatment is hormonal, in form of anti androgen or LHRH agonist injections or surgical removal of testes.

The mainstay of treatment is surgery and it can give about 75% disease free survival for 15 years which one of the maximum in cancer disease.
Dr. Ajay Sharma is performing this operation since 2005, with extraperitoneal Laparoscopic approach , as developed by French surgeons. This is a better laparoscopic technique when compared with transperitoneal approach. It has advantages of not entering the abdomen thereby reducing the risk of intestinal injury and not affecting its motility. It also prevents chances of intraabdomial infection if there is leak. There is no risk of injury to bladder and  it is more comfortable for anesthetist as patient doesn’t need to be put in extreme inclined position.

 

Since the hospital acquired a robot, the operation is being done solely by robot assistance, which in great benefit for the patient.
The surgery is not without complications. The major complication of bleeding which was  very common in open surgery (upto 1 litre blood loss)is generally not seen in laparoscopic and robotic surgery. Other complication like incontinence of urine usually improve by six months but most patients will use pads as leakage of urine is very common for first 2-3 months although by end of 3 months only few remain incontinent. Other complication is impotence. The technique whereby nerves to penis can be save, many people will retain potency.