New technology gives prostate cancer patients cutting-edge surgical options
Posted on 23 October 2018
Dr Gawie Bruwer, a urologist at Mediclinic Durbanville, explains why robotic surgery is the best and most effective way to treat prostate cancer.
Prostate cancer is the most common cancer for South African men, with one in seven local men at risk of developing the disease in their lifetime. Prostate cancer patients stand to benefit from the minimally invasive approach of robotic surgery.
Traditional prostate cancer treatments include open surgery, laparoscopic surgery, radiotherapy and hormone therapy. Many of these patients are treated with a combination. Dr Gawie Bruwer says the relatively recent introduction of robotic surgical systems is changing the way doctors plan their treatment programmes.
Brachytherapy is a form of radiation therapy where a surgeon will implant radioactive seeds directly into the cancerous prostate. This is also known as internal radiation and is used as a way to deliver high doses of radiation to very specific parts of the organ.
At a recent South African Urology Association Congress, doctors were asked if they felt brachytherapy is overused in SA, and 66% of them agreed, says Dr Bruwer.
“We find that in many cases, after we have removed the cancerous prostate, the grade of cancer is higher than we expected, based on the initial biopsies,” he says. “That’s because the biopsy only gives you a sampling of the extent of the disease.”
Without a clear picture of the histology of the prostate and the aggression of the cancer, the risk is that doctors who prescribe a course of brachytherapy may undertreat the tumour. “You will never know the histology unless you remove the organ,” says Dr Bruwer. “Once you remove the prostate, you know exactly how aggressive the cancer is, and you can act on that information quickly.”
A prostatectomy by open surgery has its own downsides, however. Apart from extensive recovery time, it can lead to urinary incompetence and erectile dysfunction.
This may explain why doctors in other areas of the world are turning to the minimally invasive option of robotic surgery, and the da Vinci Robotic Surgical System in particular. In South Africa, however, about 80% of prostate cancer patients will be prescribed brachytherapy, says Dr Bruwer. In most other developed countries, that rate is down to below 5% of cases.
Why the discrepancy? There is an issue of access, he says. “There are only five da Vinci Robotic Surgical Systems in the country right now. This is an expensive piece of equipment, and not everyone is able to be trained in using it.”
Mediclinic Durbanville is one of a handful of local hospitals to host this cutting-edge surgical system, which can help patients with prostate, testicular and colorectal cancer, among other conditions.
The Cancer Treatment Centers of America reports that the Da Vinci Robotic Surgical System offers a minimally invasive alternative to open and keyhole surgery. Its documented benefits for patients include:
- Less pain
- Lower risk of infection or complications
- Less blood loss
- A shorter hospital stay
- Less scarring due to smaller incisions
- Quicker return to normal activities
As far as a patient’s quality of life is concerned, the benefit of a shorter recovery time after the procedure can’t be overestimated, says Dr Bruwer.
“Over 90% of my robotic surgery patients go home the very next day. They have a catheter inserted for seven days, whereas open surgery patients wear a catheter for three weeks. And most of my patients now go back to work within days after surgery – before, they would be off for four weeks.”