Prostate Cancer: Understanding Diagnosis, Robotic Surgery and Treatment Options

By Dr. Yusuf Saifee | Urologist, Uro-Oncologist, Robotic & Kidney Transplant Surgeon in Indore

So, just a little background before we get started.

Dr. Yusuf Saifee is a urologist and uro-oncologist who specializes in performing minimally invasive procedures, including laparoscopic surgery and advanced robotic-assisted surgery.

His training and experience include some of the leading centres of excellence in India, including Sir Ganga Ram Hospital, New Delhi, and the Institute of Kidney Diseases and Research Centre (IKDRC), Ahmedabad.

Dr. Saifee has also had international fellowship training and surgical exposure at Guy’s Hospital, London, and Jikei University School of Medicine, Tokyo, Japan, particularly in advanced minimally invasive urological surgery and uro-oncology.

So, we’ll get started here.

We’re going to be reviewing some background information about prostate cancer. We’ll include the risk factors and prevention, how prostate cancer is screened and how we diagnose it.

We’ll also go over in detail the treatment options, including active surveillance, robotic surgery for radical prostatectomy and radiation therapies.

Some Facts About Prostate Cancer

Prostate cancer is one of the most common cancers in men.

A majority of these cancers are diagnosed in older men, particularly between the ages of 65 and 74, although younger men can also develop prostate cancer.

We do know that when prostate cancer is localized to the prostate, meaning it has not spread outside the gland, the long-term outlook is generally excellent.

So, this is one of the important reasons why early diagnosis and appropriate treatment matter.

Understanding the Prostate

So, just a little bit of an anatomy lesson.

The prostate is a walnut-sized gland that sits right next to the bladder. It sits between the bladder and the urethra, which carries urine to the outside.

It’s responsible for contributing fluid and nutrients to the semen.

As men age, the prostate naturally enlarges. This is known as BPH, or benign prostatic hyperplasia.

It does have plenty of nerves and blood vessels that travel adjacent to it, and these nerves aid in erectile function, which will become important later in our discussion of treatment options for prostate cancer.

What Are the Symptoms of Prostate Cancer?

So, what are the typical symptoms that men might experience when they have prostate cancer, or the early signs of prostate cancer?

And the answer is, honestly, not much.

Because most men don’t experience any symptoms.

Truly, the condition is diagnosed mostly based on an elevated PSA value, which is a blood test that we’ll talk about shortly.

Now, these are some possible symptoms, but I really want to point out that they are non-specific.

There might be some weakness of the stream or urinary frequency, which is worse at night.

You might experience an inability to empty the bladder completely.

There could be a stop-and-go sensation during urination or difficulty initiating urination.

You might see blood in the urine or semen, but this has a lot of potential other causes and is very non-specific for prostate cancer.

Also, if it’s more advanced at presentation, there could be persistent new back pain or bone pain in the hips or pelvis.

Again, these symptoms are non-specific. Arthritis and other conditions could be leading to this as well.

Risk Factors for Prostate Cancer

So, some risk factors for prostate cancer.

Age is one of the important factors. We know that the older men get, the more likely they are to be diagnosed with prostate cancer.

Family history is another important factor.

Men with a family history of prostate cancer, most importantly in primary relatives, that being your brothers or your father, have an increased risk.

Now, in female relatives, sisters or mothers who have breast or ovarian cancer, we do know that there is a potential link as well, sometimes associated with particular genetic mutations.

We also know that prostate cancer is influenced by testosterone, which becomes important when we discuss hormonal treatments.

There are some potential dietary factors that may play a role, but really, it’s not clear-cut.

There have been studies saying yes, studies saying no, and there’s no definite evidence that one particular food causes prostate cancer.

Can Prostate Cancer Be Prevented?

And really, the short answer is maybe.

Should we consider having a low-fat diet? Should we increase our fruits and vegetables?

Well, yes, that’s excellent for heart health and keeping ourselves healthy in other ways.

But is it really going to reduce the risk of prostate cancer by itself?

We’re not sure.

There have also been studies involving hormonal medications such as finasteride, which can reduce the likelihood of being diagnosed with prostate cancer.

But these medications are not without side effects. They can cause sexual dysfunction, low sex drive and possibly erectile dysfunction.

So, I don’t think we’re at the point of recommending that every single man should take these medications as a preventive measure.

Really, the best advice is to have healthy discussions with your physician or consult a urologist to better understand your risk factors.

Screening and Diagnosis of Prostate Cancer

For screening, this always involves a shared decision between you and your physician.

Men at average risk may consider PSA screening around the age of 45 to 50, while men with higher risk factors may benefit from earlier screening.

Now, the screening tools that we have available include PSA, which is prostate-specific antigen.

It’s just a simple blood test.

You might see that values of four or below are considered normal in some laboratory reports.

But I like to put more importance on the trend of the PSA number rather than a single value, because there are many reasons that can cause an elevation in PSA.

Another examination is the digital rectal examination.

This is where a physician examines the prostate through the rectum, checking for size, symmetry, firmness or any nodules or lumps.

We also have MRI of the prostate.

It’s not generally used as a routine screening test, but we use it as an additional investigation when PSA or examination findings raise concern.

It helps us find suspicious areas and decide whether a prostate biopsy is required.

Prostate Biopsy and Gleason Score

Using prostate biopsy to diagnose prostate cancer is something that’s been done for many years.

It’s typically done under local anesthesia or sedation.

The biopsy can be performed through the rectum, known as transrectal biopsy, or through the skin between the scrotum and anus, known as the transperineal technique.

The transperineal approach has the advantage of a lower risk of infection.

MRI-fusion or targeted biopsies have also become very common.

If we find a suspicious area on MRI, we can use that information with real-time ultrasound to target that particular spot.

Now, coming to the Gleason score.

A pathologist looks at the prostate biopsy under the microscope and assigns a score based on the cancer patterns.

If the entire sample shows pattern three, it’s called three plus three, which totals six.

If the pattern is three plus four, that’s seven.

But four plus three is also seven, and it’s generally considered more aggressive because pattern four is predominant.

Essentially, what it boils down to is that a higher Gleason score generally indicates a higher-grade cancer, and our treatment options may differ based on these risk groups.

Treatment Options for Prostate Cancer

So, for treatment options, there are several main categories.

We’re going to talk about active surveillance, surgery, which is radical prostatectomy, and radiation therapies.

There are also hormonal treatments and other treatments used in certain situations.

Active Surveillance

For active surveillance, I do want to be clear that this does not mean no treatment.

This is a treatment program, and it’s designed to preserve the quality of life and reduce unnecessary side effects of surgery or radiation.

There are many men with low-risk prostate cancers, particularly Gleason six, who may be eligible.

Generally, PSA is done at regular intervals.

We may recommend repeat prostate MRI and, in certain circumstances, a confirmatory biopsy.

This helps us make sure that the prostate cancer is not worse than what was found on the original biopsy.

Robotic Prostate Cancer Surgery

Now, for a robotic prostatectomy.

Robotic surgery in general has become an important part of minimally invasive urological surgery.

The da Vinci robotic system has robotic arms that connect to the ports placed into the abdomen.

And the robot doesn’t have a brain. That’s what some people might be skeptical about.

The surgeon sits at a console and is in total control.

The robot does not move without the surgeon controlling the instruments.

We’re able to look through a three-dimensional viewer that gives a high-definition view with excellent magnification.

So, this is minimally invasive surgery for removing the prostate.

We still consider it a major procedure, but minimally invasive in the sense that it’s performed through multiple small keyhole incisions.

The robotic instruments mimic human wrist movements, allowing an excellent range of motion inside the body.

And the advantages can include shorter recovery, less pain, less blood loss compared with open surgery and a shorter hospital stay.

For patients considering robotic prostate cancer surgery in Indore or robotic prostatectomy in India, these are some of the important advantages to understand.

How Is Robotic Prostatectomy Performed?

So, just briefly about how the surgery is performed.

The abdomen is inflated with carbon dioxide, and some space is created for us to work.

Small ports are placed into the abdomen, and the robotic arms connect to these ports.

The surgeon removes the entire prostate along with the seminal vesicles.

In selected patients, we may also remove lymph nodes from the pelvis to check whether the cancer has spread outside the prostate.

Once that is done, the bladder and urethra are stitched back together.

A Foley catheter is placed, usually for about seven to fourteen days, allowing this new connection to heal before we remove it.

Nerve-Sparing Robotic Prostatectomy

Now, a brief bit about nerve-sparing prostatectomy.

This is not for everybody.

It’s an individualized decision depending on the surgeon’s assessment, the patient’s pathology, Gleason score and MRI findings.

Our goal is always to remove the cancer and achieve a negative surgical margin.

However, we also want to preserve quality-of-life factors wherever possible.

By sparing the tissue immediately next to the prostate, we may reduce injury to the nerves that help with erectile function.

We can sometimes preserve nerves on both sides, one side or partially on either side.

But if the cancer appears to be extending outside the prostate, we don’t want to compromise cancer clearance just to preserve the nerves.

Recovery and Side Effects After Robotic Surgery

So, a typical postoperative course.

The catheter is left in place to drain the urine.

You’ll receive pain medication as needed, and we encourage you to get out of bed as early as possible.

Many patients stay in the hospital for one or two days, although this varies.

Now, the two important side effects we discuss after removing the prostate are urinary incontinence and erectile dysfunction.

There may be leakage of urine once the catheter is removed.

We instruct patients regarding Kegel exercises, which help strengthen the muscles responsible for urinary control.

Most men gradually improve, although some may experience persistent leakage.

Erectile dysfunction can also occur, even with nerve-sparing surgery.

We do know that recovery can take considerable time, and there are treatment options available to assist patients during this period.

These are important discussions to have before the surgery.

Robotic Surgery Versus Radiation Therapy

I just wanted to discuss surgery versus radiation because some of you may have that question.

And that’s a pretty hard question to answer because both are excellent treatment options, especially when prostate cancer is localized.

Radiation treatment can include conventional external beam radiation, IMRT, brachytherapy or highly focused treatments such as CyberKnife.

With surgery, we’re removing the prostate.

With radiation, the prostate usually remains in place, but the radiation is directed towards destroying the cancer cells.

Both options have their individual risks, benefits and side effects.

There are also factors that we consider, such as age, pathology, other medical conditions and the patient’s preferences regarding quality of life.

And that’s really a shared decision between you and your physician.

Prostate Cancer Treatment in Indore

For men looking for prostate cancer treatment in Indore, the first step is to understand the PSA, MRI findings, biopsy report and stage of the disease.

Not every patient requires immediate surgery.

Some may be suitable for active surveillance, while others may benefit from robotic radical prostatectomy or radiation therapy.

With training and international exposure in advanced urology, Dr. Yusuf Saifee provides consultation for prostate cancer, including evaluation and surgical treatment planning.

The important thing is to discuss all appropriate options rather than choosing a procedure simply because it is available.

Final Thoughts

So, I think the important point is that prostate cancer treatment is about options.

Some patients may require surgery, some may benefit from radiation, and some may be managed safely with active surveillance.

All these options have their own advantages, risks and considerations.

We want every patient to understand the available treatments and make a decision that is most suitable for his cancer, general health and quality of life.

And really, that’s the most important objective: to leave no questions unanswered.

For prostate cancer consultation in Indore:

Dr. Yusuf Saifee

Urologist | Uro-Oncologist | Robotic & Kidney Transplant Surgeon