Dear OncoLink "Ask The Experts,"
I have been diagnosed with stage 1 prostate cancer. I am 68 years old and have just these past 3 weeks experienced urinary retention to the point that I am now catheterized and awaiting further testing. I have a very large prostate which is causing the urinary blockage. Based on all my research, I believe my best approach would be to have my prostate removed totally rather than try to correct the blockage and then start radiation, since I am very interested in having my prostate removed robotically if I have to have it removed to correct the situation. Can you tell me if there is any reason why I would not be a candidate for this procedure? I have had no radiation or other urinary procedures performed other than a Urodynamics Test and Prostate Ultrasound. I also would like to know in your opinion why patients don't go this route rather than open surgery since it appears to be a "no brainer" compared to the open surgery procedure.
David I. Lee, MD, Chief of the Division of Urology at Penn Presbyterian Medical Center, responds:
There are a number of options in the treatment of prostate cancer and it is important for patients to be completely informed so they are confident in their decisions. Within these options are considerations based on the patients unique situation. When there is an issue such as urinary retention, surgical options come to the forefront unless there are tumor factors or patient factors that disqualify surgical treatment. Surgical expertise and experience does come into play when deciding on robotic surgery versus standard prostatectomy. Just like anything, take the time to understand your surgeons experience with the procedure. . Experience is the most important predictor for success with continence, potency, and cancer control outcomes. The robotic approach allows for quick recovery, but the other aspects are related to how many cases the surgeon has done and how often the surgeon performs the operations. So it is not as clear cut as just wanting a robotic procedure. If you have a great surgeon and they have done many open radical prostatectomies but only a handful of robotic prostatectomies, you may be better served having the open prostatectomy.