By Dr. George Kyriakou, Director of the Center for Minimally Invasive Urology at Athens Medical Center
Prostate cancer is one of the most frequent malignant neoplasms among men. The diagnosis is based on classic examination, clinical examination, prostate specific antigen (PSA) and, of course, prostate biopsy. Additionally, we can utilize the most modern techniques, such as multiparametric MRI, to fully diagnose and evaluate the extent and potential aggression of prostate cancer.
Prostate cancer has several parameters that express its aggressiveness. It is sufficient to have a high value of these parameters to characterize a high-risk disease, and the more parameters present at the same time, the higher the risk (such as a Gleason score of 7, PSA greater than 10 ng / ml. , prostatic capsular infiltration and expansion disease beyond what appears in magnetic resonance imaging).
Patients with high risk and locally advanced cancer, at the time of diagnosis, have an increased chance of developing metastases and increased cancer mortality.
Why is robotic surgery recommended in these cases as well?
In the past, cases of highly aggressive prostate cancer were considered difficult to cure and there was skepticism about the surgical treatment. Recent studies have shown that survival benefit, with the removal of prostate cancer, was higher in high-risk and locally advanced cancer patients than in low-risk patients, whereas survival in men with aggressive cancer was better for those who underwent robotic surgery compared to those who received only radiotherapy.
Similar results, in addition to survival, were also observed for the occurrence of metastases (lower odds for those who underwent surgery than those treated only with medication or radiotherapy). A further advantage of robotic prostatectomy is the eradication of a significant burden of disease and widespread lymph node excision, allowing oncologists to apply better targeted treatment and perhaps avoid unnecessary treatments that increase morbidity.
Robotic excision also avoids and reduces the incidence of local recurrence, and better controls the local progression of the disease, avoiding unpleasant complications (e.g. urinary tract blockage and renal failure). Finally, surgery per se seems to have fewer side effects than radiotherapy.
So, in conclusion, we know from the latest data that the high-risk group is the one who benefits most from surgical treatment. However, surgery in a locally advanced or aggressive form has increased technical requirements and requires an experienced surgical team. Robotic surgery, with its advantages for oncologic control and patient functional outcomes, is an excellent choice for advanced prostate cancer surgery.
In the last 2 years, we have performed over 45 cases of robotic radical prostatectomies for locally advanced cancers or high-risk cases, with extensive pelvic lymph node removal, where there is a high metastasis rate, from our robotic team at Athens Medical Center, together with my colleagues Dr. S. Tyritzis, Dr. H. Komninos and E. Frangiades. We are pleased to report that our oncological and functional results are comparable to those of international literature.
Thus, the rates of recurrence with a new rise in PSA in 2 years are absolutely encouraging, the "cleansing" of the disease to healthy limits is highly satisfactory, and the rates of post-operative urinary continence in the year exceed 92%, reaching the best rate internationally.
Finally, the rate of serious complications, which were quickly and successfully restored, is below 1.5% - among the lowest in international literature. In addition, the NeuroSAFE technique was also initiated by this team, which - with the help of a microscope and pathologist, during surgery - can rescue with oncological safety part of the erectile nerve, providing these patients with promising messages to maintain their erectile capacity, without jeopardizing the survival of residual cancer cells.
To make safer decisions, even in these locally advanced cancers, we work with specialist oncologists at Athens Medical Center for Advanced Prostate Cancer, as well as with the MDAnderson Cancer Center in Texas, and also with radiotherapists and radiologists, in the frame of multifaceted treatments after surgery.
It is worth noting that this aggressive surgical treatment, with the sophisticated daVinci SI robotic system provided at Athens Medical Center, not only offers the patient the above benefits, with a minimally invasive technique such as robotic surgery, but delays the application of other complementary therapies (radiation, chemotherapy and hormonal preparations), resulting in a better quality of life for patients.
Finally, it is worth mentioning that, in collaboration with leading oncologists, we are ready to launch a therapeutic protocol for advanced prostate cancer robotic surgery in patients who have already had one or a few more metastases, oligometastatic disease – because, as international research protocols show, it may have a very likely benefit to the local control of the disease, and perhaps to the overall survival of these patients.
In summary, robotic radical prostatectomy is considered to be the safest technique for cases of high-risk, locally advanced and possibly oligometastatic prostate cancer relative to open surgery. At the same time, it appears to be promisingly effective, according to international literature. It is important to note that combining robotic eradication of high-risk disease with other treatments (e.g. radiotherapy and medication) seems to offer longer survival rates and better quality of life than other, non-surgical treatments.