Overview of prostate cancer:
Prostate cancer is a major health issue among elderly men as it become second only to lung cancers in causing the most number of cancer-related deaths in men. It is usually found in one out of six men above the age of 70 years and in recent time, the incidence of which has seen a rapid climb probably due to early screening methods that has been incorporated. It is also considered to be the commonest cancer among men second only to the skin cancers and African American men are more likely to suffer from this condition than their Asian or Native American counterparts.
Stage at the time of detection:
The prostate cancer can vary at the time of its diagnosis and if detected early, it is more likely to be confined to the prostate and can be cured rather efficiently. But, in case the diagnosis is made late, the cancer can spread internally through to the prostate, to nearby structures such as the seminal vesicles, the bladder, rectum, lymph nodes and nerve roots, or else it can spread to distant organs such as the lungs, liver and the brain.
In its early stage or even at a time where the cancer is spread beyond the prostate, surgery would play the major role in its treatment plan and several methods in removing the cancerous tissues have been adapted. Till recent times, the gold standard in doing a prostatectomy was to make use of ‘open surgery’ which would require direct access to the prostate gland and the pelvic organs through an external incision. Following this type of surgery, the patient had to stay for several days at the hospital and there were more chances of bleeding at the site or developing complications related to respiratory tract. Furthermore, these patients need to keep the urinary catheter for 2 – 3 weeks immediately after the surgery.
Minimally invasive techniques:
With the development of laparoscopic techniques, the surgeons nowadays are using these techniques to perform ‘radical prostatectomy’ as well. In these instances, two incisions will be made from outside, just enough for a tube like structure to be inserted into the pelvis. One set of instruments would be providing a visual field and lighting for the surgical site and the other will make way for the surgical instruments to reach the site. Looking through the visuals provided, the surgeon will be able to perform the radical prostatectomy using the instruments that are given to him which can perform almost all surgical procedures that is possible through human hands.
Apart from these, certain other centers in United States are making use of a ‘robotic device’ to perform the surgery and it differs from the previous methods as the arms that manipulate the laparoscopic devices are robotic and the surgeon will control them at a different location with high resolution visual system giving him the most detail live pictures of the surgical site.
Both these methods are known as ‘minimally invasive techniques’ and would have less cuts, less bleeding, shorted hospital stay, less respiratory complications and a short duration of catheterization.
But, on the other hand, researchers have detected that, certain complications can in fact be higher among patients undergoing minimal invasive surgery as against open prostatectomy and among them, urinary incontinence and erectile dysfunctions have been listed high.
The gold standard:
Thus, the medical community is now engaged in a debate as to decide which should be the gold standard for doing radical prostate cancer surgery and most believe that, open methods should be considered as such, due to its lesser long term complications and the fact it has been time tested.