If you are thinking of having minimally invasive (laparoscopic) surgery for prostate cancer, have a family member who’s had it or just want to *really* understand how it works, you will want to read this guest article by Arnon Krongrad, MD.

Dr. Krongrad is a prostate cancer surgeon in Aventura, Florida, and Chairman of the Board of the nonprofit Prostate Cancer Mission. He was a pioneer of laparoscopic PC surgery in this country.

I wanted to learn more about minimally invasive surgery for prostate cancer because I find the topic so confusing — and it is all-important. I asked Dr. Krongrad to write about it because he has the expertise *and* the desire to communicate directly with the online PC community. That’s one thing I’m trying to accomplish with this blog — build bridges between doctors and patients.

Dr. Krongrad tells the story in a comprehensible, straightforward way, without hype. There are ample illustrations, and the doctor has agreed to answer follow-up questions about the article. If you have one, email it to me: leah@malecare.com


An Introduction to Minimally Invasive Prostate Cancer Surgery”

by Arnon Krongrad, MD

If you have been diagnosed with prostate cancer, there are some things you ought to know. Among those is that in most cases prostate cancer is not an emergency. This means that you usually have time to review options and make informed decisions about your treatment.

Surgery is one option for you if you have early prostate cancer. The operation done for prostate cancer is known as radical prostatectomy. The word “prostatectomy” means that the prostate is excised. The word “radical” means that the entire prostate is excised. When we do prostate cancer surgery we take out the whole prostate, including the external layer, known as the capsule, and attached organs known as seminal vesicles. We do this because cancer can involve them also. Depending upon specifics, your surgeon may recommend additional removal of lymph nodes and/or some of the fat and nerves next to the prostate.

Prostate cancer surgery has been around for 100 years. In the last 25 years it has been modified to take into consideration better understanding of pelvic anatomy. For example, techniques have been developed to better preserve nerves that relate to erections. Over most of its existence prostate cancer surgery was done through relatively large, open incisions of the abdominal wall.

In the early 1990s, prostate cancer surgery was for the first time done through tiny holes and without large incisions. Integrating technologies from minimally invasive (laparoscopic) gall bladder and knee surgery, the new form of prostate cancer surgery was a dramatic technical shift. You can read the surgical details in the laparoscopic radical prostatectomy technical manual (pdf). The technical shift does not represent a new type of treatment, only a modern and more gentle way of excising the prostate. For seven years, laparoscopic radical prostatectomy lay dormant. Ultimately, it was revived and brought into clinical practice. You can read a more detailed account of some of the history of laparoscopic prostate surgery.

The emergence of minimally invasive prostate surgery reflected the development of new technologies and devices. Among those is the miniaturization of surgical instruments, which allows us to put them through tiny holes. Also there is fiber optics, which permits transmission of images from the operative field to monitors that are viewed by the surgical team. Some of these technologies are necessary. Others, including a class of devices broadly grouped as “robots,” are not necessary for minimally invasive prostate cancer surgery. “Robotic prostate surgery” is a type of laparoscopic prostate surgery and use of a “robot” reflects surgeon preference.

What are “robots?” Actually, if we accept that a true robot is a device that acts without human supervision, then to the best of my knowledge there are no robots in prostate surgery. Even so, the term “robot” has come to describe a broad range of devices. These include surgeon-directed camera holders (Lap Man, EndoAssist, AESOP) and remote-controlled sewing and/or dissecting machines (LaproTek, Raven, da Vinci, Zeus). Therefore, the use of the word “robot” in the context of prostate surgery is incorrect and nonspecific. More to your point, I am aware of no evidence that in experienced hands any of these devices is superior in terms of cancer control, blood loss, pain, hospital stay, erectile function, continence or anything else that would directly matter to you.

If you are considering prostate cancer surgery, your should focus on who will do your surgery, not which gizmo will do your surgery. You should find a surgeon who consistently has very high levels of clinical success and patient satisfaction however (s)he carries out the operation. If you are having minimally invasive prostate cancer surgery, find your “Tiger Woods” and don’t micromanage the “clubs.”

We will review in a future posting why your surgeon matters and how to find a great surgeon. In the meantime, you might wish to learn more from these presentations:

There is a Lot of Hype Out There. A lecture by Dr. Jeff Cadeddu, Director of the Minimally Invasive Surgery at the University of Texas Southwestern Medical Center, to a 2007 seminar of Miami’s Prostate Cancer Mission. (15 minutes)

Robotic Radical Prostatectomy An interview by Arnon Krongrad, MD with Virgil Simon’s Prostate Net; how patients should approach prostate cancer treatment with a focus on prostate cancer surgery. (15 minutes)

Guest blogger Arnon Krongrad, MD is a prostate cancer surgeon. He is Chairman of the Board of the not-for-profit Prostate Cancer Mission and the author of “Behind the Mask,” essays about prostate problems and more.