HWN Suggests

What’s wrong with robotic prostatectomy? What’s wrong with radical prostate cancer surgery?

Radical prostate cancer surgery has been promoted by urologists as a “life-saving” treatment for over 100 years. But is this surgery safe? And does it save significant numbers of lives? Or, is radical prostatectomy just another example of an accepted medical practice for which the evidence says no, but doctors say yes? After the discovery of general anesthesia in the mid-1800s surgeons became much more ambitious. The idea for treating prostate cancer with a radical approach developed in the early 1900s because of a convergence of objectives from two other procedures.

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 Partial prostatectomy in prostate cancer: a systematic review of current evidence

Partial prostatectomy has emerged as a novel surgical option aiming to preserve urinary and sexual function while maintaining oncologic control in carefully selected patients with localized prostate cancer. • Early series suggest feasibility and safety, but long-term oncological outcomes remain uncertain compared with radical prostatectomy and focal therapies.

 Surgery regrets: I want my prostate back

The urologist diagnosed his prostate cancer. A high-tech robot removed the diseased organ. Then came two common aftereffects: sexual dysfunction and nagging questions. Was it all a mistake?

Articles of Interest

Partial prostatectomy: technically feasible, but patient selection is paramount

The goal of treating localized prostate cancer is to eradicate clinically significant cancers while maximizing preservation of urinary and sexual function. Many types of ablative therapy have emerged over the past several years, with the hope of minimizing morbidity, but with variable oncologic outcomes. As a consequence, new therapies are continually being evaluated.

Prostatectomy: Pioneering Research Gives Patients More Treatment Options

Urology has a number of white knights that have led crusades against many debilitating urologic disorders. But perhaps none is more heroic than those innovative surgeons who have led the way in treating prostate cancer. Without the pioneering spirit of a Theodore Billroth or a Hugh Hampton Young, who adapted their prostatectomies for malignancies, men with early tumors could not choose surgery as a treatment. Without the curiosity of a Patrick C. Walsh, who investigated the gland's anatomy and crafted nerve-sparing surgical techniques, they might still face the devastating side effects of previous operations.

Recent Advances in Radical Prostatectomy: A Narrative Review of Surgical Innovations and Outcomes

Prostate cancer is one of the most commonly diagnosed malignancies worldwide and is a major cause of cancer-associated morbidity in men. Radical prostatectomy (RP) is a cornerstone of intervention for organ-confined diseases and offers a potentially curative outcome. In recent decades, RP has undergone transformative changes, moving from open surgery, with significant morbidity, to minimally invasive and robot-assisted techniques

Retzius-sparing versus standard robotic-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer.

Robotic-assisted laparoscopic prostatectomy (RALP) is widely used to surgically treat clinically localized prostate cancer. It is typically performed using an approach (standard RALP) that mimics open retropubic prostatectomy by dissecting the so-called space of Retzius anterior to the bladder. An alternative, Retzius-sparing (or posterior approach) RALP (RS-RALP) has been described, which is reported to have better continence outcomes but may be associated with a higher risk of incomplete resection and positive surgical margins (PSM).

So, You Just Had A Prostatectomy… Now What?

Research tells us that usually at the one-year mark after surgery, men who do or do not go to physical therapy are about at the same place in terms of urinary continence; however, the men who do decide to go to physical therapy can regain continence and confidence a lot more quickly than those who do not go to physical therapy.

The Evolution of the Role of Radical Prostatectomy in Prostate Cancer

Dr. Leonard S. Marks provides a comprehensive analysis of the evolving role of radical prostatectomy in prostate cancer treatment. He traces the historical development of this surgical procedure, highlighting key advancements and the shifting paradigms that have shaped its current status. Nerve-sparing techniques have revolutionized the procedure by reducing the rates of postoperative erectile dysfunction and urinary incontinence. Dr. Marks details how these innovations, along with enhanced imaging techniques and robotic-assisted surgery, have refined the precision and efficacy of radical prostatectomy, making it a viable option for a broader range of patients.

The pioneers of total prostatectomy

A pivotal step in making radical prostatectomy a feasible and popular option for curative treatment of early prostate cancer was achieved by a serendipitous collaboration between a US surgeon and a retired Dutch urologist, that began in 1981. Together, they revealed as false the assumption that erectile dysfunction was an inevitable and permanent side effect of radical prostatectomy, and developed a technique that can avoid it.