Prostate cancer (adenocarcinoma) is a malignant tumor that develops from the cells of the prostate gland. It can grow slowly and stay unnoticed for years or resemble other diseases. The statistical data about prostate cancer shows that it is ahead of lung cancer and colorectal (rectal) cancer worldwide. The risk of tumor formation is 1.28% for men aged 40-59 years. In the interval from 60 to 79 years, it equals 15.6%.
When is surgery required?
It has been found that in patients with medium-grade or high-grade prostate cancer radical removal of the prostate increases life expectancy. In some patients with locally advanced cancer, surgery (radical prostatectomy) is also possible.
Types of prostate cancer surgery
The choice of prostate cancer treatment is determined by the stage of the tumor process.
For localized prostate cancer, surgical treatment (radical prostatectomy) is performed, which involves the removal of the prostate with seminal vesicles, surrounding fatty tissue, and pelvic lymph nodes.
Radical prostatectomy сan be performed with a robotic system (Da Vinci radical prostatectomy) or without, as the abdominal surgery.
Unfortunately, the conventional surgery in prostate cancer treatment often leads to complications, namely, urinary incontinence and problems with potency, because a scalpel, used in the conventional surgery, can damage the bladder and the muscles responsible for erection.
Difference between the robotic and conventional radical prostatectomy
Robotic surgery is ideal for prostate cancer treatment. Surgery is carried out in the pelvic area, which is surrounded by bones, as well as contains the bladder and nerves responsible for the erectile function, so urinary incontinence or erectile dysfunction may be the complications after surgery. An accurate and low-traumatic operation is very important for the patient's future quality of life.
Fortunately, in modern clinics, prostate cancer treatment is performed using robotic radical prostatectomy, which reduces blood loss and preserves both sexual function and normal bladder function.
Unlike other forms of prostate cancer treatment, robotic radical prostatectomy is special, because it is a laparoscopic operation (surgery without incision of the abdomen or perineum) performed by a robot controlled by a surgeon. Using the Da Vinci robot allows the surgeon to operate with higher accuracy and, as a result, reduces the risk of complications.
Benefits of the Da Vinci prostatectomy
The Da Vinci Robot Surgeon, equipped with a 3D high-resolution multi-zoom viewing system, provides the surgeon with the unique opportunity: the doctor controls the movements of tiny instruments inside the body.
Da Vinci technology allows the doctor to perform the most complex manipulations through the minimum number of tiny holes. The use of a state-of-the-art surgical system allows the physician to perform the laparoscopic operation in the most precise and least invasive way possible.
Prostate cancer surgery with a Da Vinci robot has the following advantages:
- Minimal blood loss and the need for blood transfusions during and after surgery.
- Reduced risk of postoperative complications, including prolonged pain, urinary problems, infection, and inflammation.
- Shorter hospital stay and the rehabilitation period. Robotic radical prostatectomy facilitates return to the usual lifestyle and physical activity.
- Effective restoring of the functional capabilities of the male body: the use of the Da Vinci robot helps to preserve healthy tissues and nerve bundles, which ensure recovery of urinary and erectile function. The term of restoring sexual activity and potency is individual and can take from several months to a year. According to reviews of men under 50, the chance of restoring potency after a robotic operation exceeds 90%.
- Reduced risk of death: according to numerous studies, prostatectomy has the lowest risk of death compared to non-surgical medical treatments for prostate cancer. The risk of death in the treatment with radiotherapy is more than 2 times higher than that in surgery.
How is robotic prostate cancer surgery carried out?
Operation by a Da Vinci robot is called the robotic radical prostatectomy. The operation is performed under general anesthesia and lasts 3 hours maximum.
The prostate cancer surgery is performed with precise instruments, the size of which is only a few millimeters.
To penetrate the prostate, five punctures are made in the lower abdomen, in size of less than one centimeter each. Three operating instruments and two tubes with miniature video cameras are inserted into the holes, which serve as the eyes to an urologist. With the help of these cameras, a 3D image is projected onto the screen with a 15-20 times magnification, which contributes to the maximum accuracy of the surgeon's actions and significantly reduces the likelihood of any complications after the procedure.
During the laparoscopic operation, the prostate gland and seminal vesicles are removed. Depending on the stage and grade of cancer, the surgery can remove the lymph tissue outside the prostate gland, which the pathologist examines for cancer cells afterwards.
The urethra, which runs inside the prostate, is trimmed near the sphincter and bladder. After removal of the prostate, the bladder is sutured to the urethra. The catheter is placed through the urethra into the bladder until the sutures heal.
During a robotic-assisted radical prostatectomy, a telescopic lens is inserted into one of the channels, providing a three-dimensional and enlarged image of the delicate structures surrounding the prostate (nerves, blood vessels, and muscles), thereby maximizing the preservation of these vital structures that ensures benefits of robotic surgery procedure.
Throughout most of the laparoscopic operation, the surgeon sits at the console and controls the instruments with his fingers. The operation is carried out following the same surgical principles as in the open surgery, but without introducing the surgeon's hands into the patient's abdominal cavity.
These operating instruments can move in all directions at a 90-degree angle to provide the same maneuverability as a human hand. The robot's arms repeat the movements of the doctor's hands as accurately as possible.
Is there a need for additional treatment procedures?
The pathologist examines the removed histological specimens under a microscope after the operation. Thus, it is possible to understand the specifics of cancer, the local spread of cancer cells, as well as the possibility of their metastasizing to the lymph nodes. Prostate cancer surgery is sufficient if there are no cancer cells around the edges of the removed tissue. Surgery may be complemented by radiation therapy or hormonal therapy if cancer grows through the prostate capsule or along the edges of the tissue removed from the specimen, or if cancer cells are present in the lymph nodes.
Complications after prostatectomy
The surgery can cause the following complications:
- Inflammation and venous thrombosis in a small number of patients
- Damage of the intestines, especially if there are adhesions and scars in the abdominal cavity after previous operations
Significant postoperative complications after radical prostatectomy occur in less than 1% of patients. Potential long-term complications after radical prostatectomy are urinary incontinence and erectile dysfunction (impotence). Urinary incontinence is temporary in about 90-95% of patients. Erectile ability and erectile nerves are likely to be preserved in patients with small tumors. Most of the postoperative complications are temporary.
Prices for robotic radical prostatectomy
Although the operation price in treatment abroad is high, the overall cost is reduced due to shortening the patient's hospital stay. After robotic surgery, in most cases, the patient is discharged from the hospital in 1-2 days. After the abdominal surgery, the price of which is high as well, it is necessary to spend from 3 to 6 days in the hospital. The cost also lowers since during robotic surgery for prostate cancer treatment the patient loses on average only 200 milliliters of blood. Since blood loss is significant during standard surgery, the patient needs 0.5 to 1.5 liters of donated blood.
The average prices for robotic interventions are as follows:
- Germany – from 20,000 EUR
- Israel – from 22,000 EUR
- Turkey – from 11,000 EUR
Where can I undergo robotic radical prostatectomy treatment abroad?
Successful performance of prostate removal operations, specifically robotic radical prostatectomy, requires vast experience with the Da Vinci robot and surgical skills. Besides, the Da Vinci robot costs a lot of money, and a set of disposable tools costs several thousand euros. That is why robotic radical prostatectomy is performed in a very small number of specialized clinics.
Among German hospitals, the best success rates in robotic radical prostatectomy of prostate cancer treatment are demonstrated by:
- University Hospital of Ludwig Maximillian University of Munich, Department of Adult and Pediatric Urology. The department ranks among the TOP German departments specializing in prostate cancer treatment. It is certified as the Prostate Cancer Center according to the standards of the German Cancer Society. This fact confirms the credibility of the department in the field and the high success rates in prostate cancer treatment.
- Marien Hospital Marl, Department of Adult and Pediatric Urology. For the comprehensive and most effective medical treatment of prostate diseases, the department has a specialized center, which was the first in the Recklinghausen region and the second in Germany to be certified by the international quality standard DIN EN ISO 9001.
- University Hospital Saarland Homburg, Department of Adult and Pediatric Urology. A unique feature of the department is the Da Vinci Robotic Surgery Center, within which a number of effective minimally invasive procedures for the medical treatment of prostate cancer were performed (more than 3,700 successful prostatectomies, starting from 2006).
How can I undergo prostate cancer treatment abroad?
Reasonably enough, the organization of medical treatment abroad can seem a little bit too much. It requires specific knowledge and experience in medical tourism. It is safer, easier, and less stressful to shift some responsibility onto a medical tourism agency.
Booking Health is the largest and most transparent medical tourism agency in the world. Medical treatment abroad is arranged due to the direct cooperation with leading foreign hospitals.
Booking Health provides the following services:
- Selection of treatment program and medical facility
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To undergo medical treatment abroad, please leave a request on our website. The medical tourism coordinator will contact you within a few hours.