What minimally invasive prostate cancer treatments exist?
The gold standard treatment for prostate cancer is laparoscopic removal of the affected gland. There are other treatments such as radiotherapy, but it has been proven that, in the long term, prostate removal treatment is more curative than any of the others. This does not mean that laparoscopic removal cannot or should not be complemented with radiotherapy, in certain cases, for example when after surgery there is an elevation of the prostate specific antigen (PSA).
In any case, the most important thing in this disease is to visit the urologist once a year after the age of 40, if there is a family history of prostate cancer, or after the age of 50 if there is not.
What does laparoscopic removal of the gland consist of?
It consists of removing the prostate, seminal vesicles and, in some cases, the lymph nodes through three or four small incisions. This procedure, in trained hands, should take little more than an hour and is generally very well tolerated by patients. And, of course, with usually negligible blood loss.
The first thing to be performed is a biopsy. With the positive result, the intervention can be planned without getting nervous about the time; in prostate cancer we have the advantage that since it is a very slow-growing cancer, it allows us this peace of mind to be able to look for the most appropriate date.
What are the results obtained with this surgery?
The result, if the indication is well done, is usually the cure of the disease. But, as in all tumors, subsequent check-ups and PSA (blood tests) are fundamental. The PSA will be of fundamental utility, as long as the levels are very low (value of 0.1 or less) there is no problem; another very important point is that this value, even if it is higher at the beginning, does not increase in the successive revisions.
A correct follow-up would be to do the first PSA one month after the intervention, and then every 6 months for the first two years. Subsequently, it will be done annually and preferably for 10 years.
When is this type of operation indicated?
It is always indicated when the existence of cancer is first confirmed by biopsy, and once the urologist has demonstrated with the pertinent studies that the disease is localized only in the prostate.
These studies usually consist of a CAT scan or abdominal MRI and a bone scan. With these studies performed we can practically say with total certainty that the problem is confined to the prostate.
In addition, we must consider that the general health conditions of the patient allow this treatment, so we must always do a preoperative study with complete analysis, electrocardiogram and chest x-ray.
What is the postoperative period like?
The postoperative period is usually very comfortable, the patient gets out of bed in a few hours, as there is no wide skin or muscle incision. There is hardly any postoperative pain, many patients can be at home after three days, although the probe must be kept in place for a few more days.
Once this catheter is removed, urinary incontinence usually appears, which, with some simple exercises, usually evolves well in a short period of time; only 3% may be left with permanent incontinence and, to solve this, another intervention would be necessary.
Another issue of concern to patients is the sexual sphere after surgery. Nowadays, with existing pill treatments this is usually not a problem.