Robotic radical prostatectomy has been the most common method of treatment for early prostate cancer. In the last decade, surgical treatment of prostate cancer has evolved from open retropubic radical prostatectomy to minimally invasive radical prostatectomy.
Laparoscopic radical prostatectomy has a step learning curve but in the hands of an experienced surgeon, the results as just as good as robotic prostatectomy. Robotic prostatectomy on the other hand, has a shorter learning curve. However, there is the inherent capital cost burden of the purchase of a robotic system.
The following review article by Skarecky reviews the technical aspects of the evolution of radical prostatectomy surgery in the last 10 years. It gives a very detailed account of a technique adopted by one of the pioneer centers for robotic prostatectomy surgery.
Department of Urology, University of California, Irvine, CA 92697, USA
We look forward to the next 10 years of rapid development in the treatment of early prostate cancer and the possible emergence of robotic radical prostatectomy being the standard of care for this disease.
In Singapore, there are 3 centers in restructured hospitals and Mount Elizabeth Hospital (Orchard and Novena) in private practice offering robotic radical prostatectomy. The newly opened Mt Elizabeth Hospital houses the newer 4 arm da Vinci robotic system.
The American Urological Association (AUA) during the May 2013 AUA Annual Meeting issued guidelines on screening of prostate cancer. Men aged 55 to 69 years who are considering prostate cancer screening should talk with their doctors about the benefits and harms of testing and proceed based on their personal values and preferences. The new guideline updates the Association’s 2009 Best Practice Statement on Prostate Specific Antigen (PSA).
This contrasts with the statement from the U.S. Preventive Services Task Force issued by USPSTF Co-Chair Michael LeFevre, M.D., M.S.P.H. in May 22, 2012 which quoted: “Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”
It is clear is that prostate cancer screening is NOT recommended for men below 40 years old. Routine screening in men between 41 and 54 years old with average risks is also not recommended. The guidelines also state that, to reduce the harms of screening, a routine screening interval of 2 years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of 2 years preserve the majority of the benefits and reduce overdiagnosis and false positives. Finally, routine PSA screening is not recommended in men over age 70 or any man with less than a 10- to 15-year life expectancy.
What should we recommend to our patients? Should we continue doing PSA testing? Should we underestimate the seriousness of prostate cancer which is the 3rd most common cancer in Singapore and seen much fatality every year?
The general public and patients with prostate diseases are confused on these very differing opinions from very renouned professional bodies. Our centre are with the opinion that prostate cancer remains an important disease in some individuals that will require treatment. We are challenged in identifying this group of individuals as the currently available tests such as PSA does not have a high specificity for prostate cancer.