MelbourneROBOTICPROSTATECTOMY

Diagnosis

In many instances, prostate cancer is silent (i.e. it causes no symptoms), and is diagnosed on the basis of abnormalities found on examination of the prostate or increased levels of Prostate Specific Antigen (PSA).

PSA is a substance made within the prostate, and secreted into semen, where it has an important function in maintaining a fluid environment for sperm. Some PSA gets into the blood-stream, where it can be measured in laboratories by taking a blood sample. The PSA level can be increased by diseases of the prostate including enlargement, infection, inflammation and cancer. The PSA level is decreased, sometimes down to zero, following treatments to the prostate.

Men aged 50 years or more are advised to have an annual check-up consisting of an internal examination (referred to as a digital rectal examination or DRE) and a blood test to measure the PSA. If an abnormality is noted in either case, a biopsy of the prostate gland is required to establish the diagnosis of prostate cancer.

Sometimes, prostate cancer is diagnosed because men report difficulties with urination or bleeding, although these symptoms may also be caused by co-existing benign prostatic enlargement (BPH). If the cancer spreads beyond the prostate, it may result in bone pain, fractures, abdominal pain, generalized weakness, tiredness and weight loss.

Prognosis

Overall, prostate cancer differs from many other cancers in being slow-growing and in many instances is non-lethal. Nonetheless, many men continue to die of prostate cancer, and it causes much suffering. The potential for a particular cancer to behave aggressively can be assessed by a number of different factors:

• Stage: the extent of the cancer, assessed by examination & scans
• Grade: aggressiveness of cancer, assessed pathologically
• PSA: the level and rapidity of increase (if known)
• Amount of cancer: assessed as a proportion of the biopsy

The above parameters may be used to assess the probability of spread of cancer, and therefore the likely success of treatments. In simpler terms, a distinction needs to be made between localized prostate cancer (i.e. one contained within the prostate gland, suitable for curative treatment) and metastatic prostate cancer (i.e. one that has spread beyond the prostate gland, and is no longer curable).

Treatment for localised cancer

Multiple options are available for the treatment of localized prostate cancer, with the final choice dictated by the type of cancer, other co-existing problems (such as prostatic enlargement or bowel disease), availability of treatment facilities and to some extent patients’ preferences. For aggressive varieties of prostate cancer, the use of more than one type of treatment may be recommended.

Surgery (radical prostatectomy) for prostate cancer consists of the removal of the prostate gland along with the seminal vesicles (additional male sexual glands) and the ends of the vasa (which bring sperm from the testes to the back of the prostate). Radical prostatectomy may be performed using the daVinci(TM) robotic surgery system, simple laparoscopy or conventional open incision.

Alternatives to surgery for prostate cancer include radiotherapy administered externally or internally by placement of radioactive seeds (also known as brachytherapy), active surveillance (close observation, with the intention of delayed selective curative treatment) and newer investigational treatments such as high-intensity focused ultrasound (HIFU) and cryotherapy (freezing of the prostate).

Treatment for metastatic cancer

Metastatic prostate cancer is treated by removing the male hormones (known as androgens, e.g. testosterone), which leads to shrinkage of the cancer and slowing of its growth. Hormonal therapy may be carried out by surgically removing the testicles or by using medications to shut down the testicles.

Hormonal therapy is usually effective for a variable length of time (typically months or even years). Ultimately, the cancer begins to grow despite the hormonal therapy, in which case it is said to be hormone-refractory prostate cancer, and is potentially life-threatening. At this stage, chemotherapy or alternative drug therapy may be recommended.