Frequently Asked Questions About Prostate Cancer and Robotic Surgery

Many patients have some common questions about robotic-assisted prostate cancer surgery.

When should I get a prostate exam?
A prostate-specific antigen (PSA) test is used to detect elevated levels of this protein, produced by the prostate, which can indicate prostate cancer or other prostate diseases. Please talk to your physician to determine if a PSA screening is right for you. However, if you have a family history of prostate cancer or if you are African-American, you should have a prostate exam at age 40.

What is the best way to detect prostate cancer?
Rectal exams are still the best way to detect abnormalities. After this, a biopsy may be performed to check for cancer cells.

I have a low PSA. Could I still have prostate cancer?
PSA tests can be affected by several factors, including infection, sexual activity, riding a bike or trauma. They are not a direct indicator of cancer cells. However, if your PSA goes up, your risk of cancer also goes up.

What is the benefit of having a robotic-assisted prostatectomy (removal of the prostate) surgery versus a conventional prostatectomy surgery?
Our goal is to provide a treatement option that is best for you. In general, robotic-assisted surgery is less invasive. Conventional surgery requires a large, open incision in the lower abdomen while robotic-assisted surgery only requires a series of small incisions.

There is less pain and a quicker recovery time with robotic-assisted surgery (approximately three weeks versus three months). Robotic-assisted surgery also offers a lower potential for incontinence and impotence, mainly because the accuracy of the instruments helps the surgeon spare the delicate nerves. There is also potentially less scar tissue, less blood loss and a lower risk of infection.

Michael, Robotic Prostate Surgery Patient Story
Michael underwent robotic surgery to treat prostate cancer.

If I have a robotic-assisted prostatectomy, what are my chances of having urinary incontinence or impotency?
The added control provided by the da Vinci system helps the surgeon preserve the surrounding tissue and delicate nerves necessary for continence and potency. There is a period of time (several months) during recovery in which you will have some urinary incontinence or leakage; however, after one year 98 percent of patients have regained continence. During the recovery period, you may be referred to a pelvic  floor physical therapist who will help you learn exercises to strengthen the pelvic floor muscles.

It is difficult to determine statistics for potency; however, recovery rates have been shown to be higher with robotic-assisted surgery.

What can be done to treat impotence or incontinence if it occurs?
Sharp offers multiple modalities in treating impotence or incontinence. Impotence can be corrected with medication, injections, vacuum devices or with a penile implant.

Urinary incontinence is correctable with an artificial sphincter or sling procedure. The artificial sphincter procedure involves an implanted device that fits around the urethra (the tube that carries urine from the bladder to the outside of the body) and keeps the urethra closed until the patient is ready to urinate. The sling procedure involves wrapping a strip of material around the urethra and attaching the ends of the strip to the pelvic bone. The sling keeps constant pressure on the urethra so that it does not open until the patient consciously releases the urine. 

What happens during a robotic-assisted surgery?
The surgeon starts by making a series of small incisions in the abdomen and guiding the instruments through the incisions. The surgeon sits at the console and guides the micro-instruments to detach the prostate as cleanly as possible. The prostate is then removed through a small incision and the bladder is reattached to the urine channel. A surgical assistant and physician are at the patient’s side the entire time.

What happens after the surgery?
After the surgery, many patients go home within 48 hours. Patients have a catheter for one week and can only participate in light activity for 30 days.

What if all of the cancer cannot be removed?
In some cases, patients need follow-up treatment with external beam radiation. Patients may be treated using the Novalis®-Shaped Beam Surgery radiation system, which is designed to conform the radiation to the shape of the area that needs to be radiated, therefore limiting damage to other tissues and decreasing the risk of side effects such as incontinence or impotence.

How often do patients receive radiation treatment?
Radiation treatments are given Monday through Friday for eight weeks.

Are there other options?
Another option is to have radioactive seeds (about the size of a grain of rice) implanted into the prostate. The seeds stay in over a period of several weeks or months. This treatment is not appropriate for men who are experiencing swelling around the urethra and having difficulty urinating.

What is the difference between the robotic-assisted surgery and laparoscopy?
The da Vinci system provides three-dimensional vision to the surgeon, whereas laparoscopy is only two-dimensional. The da Vinci system also magnifies what the surgeon sees. The improved image, combined with instruments that articulate and rotate 360 degrees.

How long have surgeons at Sharp HealthCare been performing robotic-assisted surgery?
In 2005, Sharp HealthCare was the first to bring robotic-assisted surgery to San Diego.

How many prostatectomies have your surgeons performed?
Sharp-affiliated surgeons have performed more than 430 robotic-assisted prostatectomies.

If the cancer has spread to other parts of the body, should I still have a prostatectomy?
If the cancer has spread, robotic-assisted surgery may be used to de-bulk the tumor. The surgery is one part of the treatment plan. Usually patients also receive chemotherapy or hormone treatment. 

Can’t I just wait it out — do I really need surgery?
Watchful waiting can be an option. However, it can affect your long-term outcome since it is possible to lose your "window of curability." If the cancer progresses, it is more difficult to treat.

What if the computer crashes?
The da Vinci robotic system provides assistance to the physician but cannot function on its own. The surgeon controls the robot and directs its movements. As with any procedure, Sharp has full contingency plans for any equipment issues. We are pleased to say that since first using the robot beginning in 2005, Sharp's robots have never experienced an unexpected downtime during a procedure.

What if there is a power failure?
Sharp is fully equipped to continue caring for patients throughout the hospital in the event of a power outage. Every facility has reserve power generators, which automatically take over if needed.

Where is robotic-assisted prostatectomy surgery offered?
Sharp HealthCare offers da Vinci prostatectomy surgery at Sharp Chula Vista Medical Center, located in South County, Sharp Grossmont Hospital, located in East County, and Sharp Memorial Hospital, located in central San Diego.

How to Choose da Vinci at Sharp
Sharp accepts almost all health insurance. For help finding a surgeon who specializes in robotic-assisted surgery or to schedule a consultation, call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.

For More Information
For general information about prostate cancer, please read Prostate Cancer in Adult Health.