a new approach to prostate cancer

A new approach to prostate cancer


Prostate cancer is the most common cancer among men (after skin cancer) and is the second leading cause of death. Fortunately, it can be treated successfully if we have an early diagnosis.

Anatomically, the prostate gland is located around the proximal part of the urethra, below the bladder, in front of the rectum and behind the pubic bone. Just behind the prostate are glands called seminal vesicles glands that store and produce the majority of the fluid that makes up semen. The urethra is the tube that carries urine and semen out of the body through the penis. The size of the prostate can change with age. In younger men, it is about the size of a walnut, but it can be much larger in older men.

Prostate cancer begins when cells in the prostate gland start to grow out of control. Almost all prostate cancers are adenocarcinomas which develop from the cells in the prostate gland. Some prostate cancers grow and spread quickly, but most are fairly slow giving us time to obtain a diagnosis before any symptoms appear. A diagnosis is reached by biopsy which must be done should the result of the PSA (blood test) be suspicious.

Prostate cancer is divided into two big groups – the localised disease, where we aim to cure the patient, and the metastatic or advance disease where our aim is to increase the survival rate of the patient while maintaining a good quality of life. Surgery is a common choice to try to cure prostate cancer. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.

In the more traditional approach in a radical prostatectomy, the surgeon operates through a single long skin incision (cut) to remove the prostate and surrounding tissue. This is known as an open surgery.

In the last two decades, minimally invasive surgery began to evolve and is now a common option in most top institutions. In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate (keyhole surgery). If done by experienced surgeons and teams, the laparoscopic radical prostatectomy has better functional results and the post-operative recovery is much improved.

A radical laparoscopic prostatectomy is a challenging procedure that was mostly replaced by robotic-assisted surgery. A considerable number of difficult manoeuvres, and a technically-challenging vesical-urethral anastomosis near the end, make it one of the most advanced laparoscopic surgeries in urology. The use of articulated devices, especially if robotic, is very attractive and can help the surgeon overcome these difficulties, achieving better results.

In the HPA Health Group, urologists have been using this technique with very good results. This experience will soon be presented at an international congress in Vienna this September where we will be showing the impact of introducing these devices, not only in the length of operation time, but also perioperative complications and results.

By Prof. Tiago S. Rodrigues

Prof. Tiago S. Rodrigues is a urologist at both the Hospital in Alvor and in Gambelas, with experience in minimally invasive surgery and robotic forceps.