Prostate Cancer

Robotic Prostatectomy

The prostate is a walnut sized organ located just below the bladder that forms the junction between the male reproductive and urinary tracts and secretes fluid that makes up part of the semen.

A robotic prostatectomy is a treatment option for prostate cancer in particular situations. There are several key investigations and procedures that need to be performed prior to this operation.

Perth Robotic Prostatectomy
Robotic surgery for the prostate
MRI

If your cancer was diagnosed by Mr Thyer you will most likely have undergone MRI prior to the biopsy. If you have been referred from another urologist you may require prostate MRI to ensure the cancer is able to be treated successfully with surgery

Staging
  • To ensure the prostate cancer is contained within the prostate a PSMA PET scan is usually required
  • Occasionally no scan is required for low grade disease particularly if the PSA is very low
  • PSMA PET can be expensive so a bone scan and CT are a cheaper option although not considered to be as accurate as PSMA PET
Discussion about options for treatment
  • Generally low risk prostate cancer can be observed and does not require treatment
  • Surgery and radiotherapy have roughly equivalent rate of cure for prostate cancer
  • Surgery for prostate cancer is favoured for younger men with prostate confined cancer
  • Radiotherapy is favoured for older men particularly if the prostate cancer looks to be growing outside of the prostate on MRI
  • Hormone therapy is recommended for older men where the cancer has spread to lymph nodes, other organs or bone
  • Men with high risk prostate cancer will likely require a combination of surgery, radiotherapy and possibly hormonal therapy for cure
Waiting for surgery

After prostate biopsy the inflammation around the prostate will take about 6-8 weeks to settle. For safety reasons surgery to remove the prostate needs to wait until this period has elapsed.

Perth robot surgery urologist
Prostatectomy: open surgical incision vs da Vinci prostatectomy incision
Risks of radical prostatectomy (these are the main risks and this is not an exhaustive list):
  • Bleeding
  • Conversion to an open operation
  • Infertility
  • Anejaculation
  • Cancer recurrence
  • Positive surgical margin
  • Incontinence
  • Erectile dysfunction
  • Rectal injury
  • Ureteric injury
  • Urine leak from the anastomosis
  • Heart attack
  • Stroke
  • Lung infection
  • Bladder infection
  • Venous thrombo-embolism
  • Very small risk of death
Physiotherapy
  • All men will need to see a specialist pelvic floor physiotherapist at least 3 weeks prior to the operation to ensure you understand how to contract the pelvic floor. This will assist with recovery of continence post operatively
  • Those who are experiencing incontinence after the operation will need follow up with the physiotherapist to help regain control. If you are continent you may not need to see the physiotherapist again.
Flexible cystoscopy
  • Every man’s anatomy around the prostate is slightly different. Mr Thyer will perform a flexible cystoscopy (look in the bladder via the penis) with a small telescope prior to the operation to check on your anatomy.
  • Flexible cystoscopy may have already been performed at the time of biopsy if you had your biopsy with Mr Thyer.
Prostate cancer nurse
  • You will need to have contact with a prostate cancer nurse at first diagnosis
  • Prostate cancer nurses will provide you with information and support throughout treatment for prostate cancer
  • Francesca Leggott works out of Mr Thyer’s rooms at Hollywood and you will have the opportunity to speak with her each time you see Mr Thyer
  • Lisa Ferri is based a Hollywood Hospital and will see you at the time of flexible cystoscopy
  • Julie Sykes is based in the Joondalup rooms and will be available at consultations at that location
Weight loss
  • Most men are asked to lose weight prior to surgery
  • Weight loss
    • Improves Mr Thyer’s vision at the time of the operation
    • Shortens the length of procedure
    • Improves recovery of continence post operatively
    • Reduces peri-operative risk
  • Francesca Rogers will contact you pre operatively to ensure you have a weight loss plan
  • Hollywood Hospital has a complete pre-operative allied health service to assist people to lose weight and achieve peak condition prior to surgery
Pre-operative blood and urine tests
  • These tests need to be performed at least 10 days prior to the operation with Western Diagnostic Pathology
  • If there is a urine infection you will need to take a course of antibiotics prior to the operation
Blood thinning medication
  • If you take any blood thinning medication including aspirin or fish/krill oil, please let Mr Thyer’s secretary know at least 3 weeks prior to the scheduled surgery date

The operation

  • Robotic radical prostatectomy is removal of the whole prostate performed in a minimally invasive technique
  • The procedure involves 5 small incisions and a slightly larger incision above the umbilicus to remove the prostate once the procedure is finished
  • The bladder is sutured back to the urethra once the prostate is removed and a tube (catheter) is placed in the bladder which will stay for 5-10 days. You may also have a drain overnight after the operation.

After the operation

In hospital
  • Most people stay 1-2 nights after the operation
  • You will need to move around your hospital room, sit out of bed for meals and walk around the ward as early as possible after the operation in order to limit the chance of lung infection, bowel issues and blood clots
  • Mr Thyer will see you the day following the operation to check on progress
When you go home
  • Stay mobile – walk for 5-10 minutes every hour
  • Keep your compression stockings on for 3 weeks
  • Do not drive a motor vehicle for 6 weeks unless cleared earlier by Mr Thyer
  • Do not lift anything over 5kg, play sport or perform heavy physical activity for at least 6 weeks
  • No sexual activity for 6 weeks
  • Call Mr Thyer via Hollywood Hospital switch board if:
    • your catheter suddenly stops draining or falls out
    • you have a fever of 38 or higher
    • a wound looks infected (pus or spreading redness around the wound)
    • If you have any other issues, please call the after-hours nurse at Hollywood Hospital (if you had your operation performed at Hollywood) or go to the emergency department at Joondalup (if your operation was performed at Joondalup Hospital)
  • Do not allow anyone to remove or replace your catheter unless checked with Mr Thyer first
Catheter removal
  • This will take place at Hollywood Hospital with continence nurse Leslie Pitman 5-10 days after the operation
  • Antibiotics will be given to you when leaving hospital. These need to start 2 days prior to catheter removal
First post-operative visit (3 weeks)
  • To see Mr Thyer with pathology result, check progress and check wounds
  • Depending on the pathology result you may need further treatment to ensure maximum chance of curing the cancer.
  • Do not have a PSA test performed prior to this visit
  • Francesca will also talk to you about recovery of sexual function and any ongoing continence issues at this visit
Second post-operative visit (8 weeks)
  • To see Francesca in Mr Thyer’s rooms with first PSA check
  • Francesca will also talk to you about recovery of sexual function and any ongoing continence issues at this visit
Ongoing surveillance
  • PSA checks will be conducted with Francesca from Mr Thyer’s rooms every 3 months initially then less frequently with time. PSA checks will continue indefinitely at widening intervals. If your PSA becomes detectable in future, then you will be seen by Mr Thyer and discussion on further treatment options will be had.

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