Uro Oncology: Procedures

Prostate Cancer Procedures:

For localized prostate cancer, a prostate biopsy is the initial diagnostic procedure, usually performed using transrectal ultrasound (TRUS)-guided biopsy or MRI fusion biopsy for higher accuracy. Once diagnosed, treatment options include radical prostatectomy, where the prostate gland is surgically removed, either through open surgery, laparoscopic surgery, or robotic-assisted surgery (da Vinci system). Focal therapies, such as high-intensity focused ultrasound (HIFU) and cryotherapy, can target and destroy cancer cells in specific areas while preserving healthy prostate tissue.

For advanced prostate cancer, radiation therapy is commonly used, including external beam radiation therapy (EBRT) and brachytherapy, where radioactive seeds are implanted into the prostate. Hormone therapy (androgen deprivation therapy, ADT) is another common approach to slow cancer growth. PSMA-targeted radioligand therapy is an emerging treatment for metastatic prostate cancer, delivering radiation directly to cancer cells.

Kidney Cancer Procedures:

For kidney cancer, the most effective treatment is surgical removal of the tumor or kidney, depending on the stage. Partial nephrectomy (nephron-sparing surgery) is preferred for smaller tumors to preserve kidney function. This can be done via open surgery, laparoscopic surgery, or robotic-assisted surgery. For larger tumors, a radical nephrectomy is performed, where the entire kidney is removed, along with surrounding tissues and lymph nodes if necessary.

For patients who are not surgical candidates, thermal ablation techniques, such as radiofrequency ablation (RFA) or cryoablation, can destroy cancer cells using heat or freezing temperatures. Arterial embolization is another option, where the blood supply to the tumor is blocked to shrink it before surgery or as a palliative measure.

Bladder Cancer Procedures:

For non-muscle-invasive bladder cancer (NMIBC), the most common procedure is transurethral resection of bladder tumor (TURBT), where a cystoscope is inserted into the bladder to remove cancerous tissue. This is often followed by intravesical therapy, such as BCG immunotherapy or chemotherapy, to reduce recurrence risk.

For muscle-invasive bladder cancer (MIBC), a more aggressive approach is needed. A radical cystectomy may be performed, where the bladder is removed along with nearby lymph nodes and, in some cases, reproductive organs. In men, this may include the prostate, and in women, the uterus or part of the vagina. Urinary diversion surgery, such as an ileal conduit or neobladder reconstruction, is required to create a new way for urine to exit the body.

Testicular Cancer Procedures:

The primary procedure for testicular cancer is radical inguinal orchiectomy, where the affected testicle is surgically removed through an incision in the groin. This procedure is both diagnostic and therapeutic. Retroperitoneal lymph node dissection (RPLND) may be performed to remove lymph nodes in cases where the cancer has spread.

For advanced testicular cancer, chemotherapy or radiation therapy may be required after surgery. Testicular prosthesis implantation is an option for cosmetic and psychological reasons. Minimally invasive techniques for lymph node removal are being explored to reduce long-term complications.

Minimally Invasive and Robotic Procedures

Robotic-assisted surgeries, such as robotic prostatectomy, robotic nephrectomy, and robotic cystectomy, are becoming the preferred methods due to their precision, reduced recovery time, and lower risk of complications. These techniques allow surgeons to operate with enhanced dexterity and visualization, improving patient outcomes.

      What is a Robotic Prostatectomy?

            Robotic prostatectomy is a minimally invasive surgical procedure used to remove the prostate gland in patients with prostate cancer. This technique utilizes the da Vinci robotic system, which allows surgeons to perform the procedure with enhanced precision, flexibility, and control. The robotic system consists of a console where the surgeon operates using hand controls, while robotic arms equipped with tiny surgical instruments and a high-definition 3D camera perform the surgery inside the patient.

The key benefits of robotic-assisted laparoscopic prostatectomy (RALP) include smaller incisions, reduced blood loss, shorter hospital stays, and faster recovery times compared to traditional open surgery. Additionally, the robotic system allows for more precise removal of cancerous tissue while minimizing damage to surrounding nerves, which can help preserve erectile function and urinary continence. Postoperative recovery is typically quicker, with most patients resuming normal activities within a few weeks.

      What is a Robotic Nephrectomy?

            Robotic nephrectomy is a minimally invasive procedure used to remove all or part of a kidney affected by cancer, severe kidney disease, or other conditions. It is performed using the da Vinci robotic surgical system, which provides enhanced visualization and dexterity for the surgeon. The procedure can be classified into two main types: robotic partial nephrectomy, where only the tumor or affected portion of the kidney is removed, and robotic radical nephrectomy, where the entire kidney is removed along with surrounding tissues, if necessary.

The robotic approach offers several advantages over traditional open nephrectomy, including smaller incisions, less postoperative pain, quicker recovery, and reduced risk of complications. Robotic partial nephrectomy is particularly beneficial because it allows surgeons to precisely remove the tumor while preserving as much healthy kidney tissue as possible, maintaining better long-term kidney function. Patients typically experience a shorter hospital stay and faster return to normal activities compared to open or even standard laparoscopic kidney surgeries.

       What is a Robotic Cystectomy?

            Robotic cystectomy is a minimally invasive procedure used to remove the bladder in patients with muscle-invasive bladder cancer or other severe bladder conditions. The da Vinci robotic system assists surgeons in performing either a partial cystectomy (removing part of the bladder) or a radical cystectomy (removing the entire bladder along with nearby lymph nodes and, in some cases, reproductive organs).

One of the major advantages of robotic cystectomy is its ability to provide a nerve-sparing approach, which can improve post-surgical urinary function and, in male patients, reduce the risk of erectile dysfunction. Additionally, robotic-assisted techniques allow for more precise removal of cancerous tissue while minimizing blood loss and reducing complications. After bladder removal, a urinary diversion procedure is performed to create a new way for urine to exit the body, such as an ileal conduit or neobladder reconstruction.

Overall, robotic-assisted surgeries for prostate, kidney, and bladder cancers are revolutionizing the field of urology by improving surgical precision, reducing recovery time, and minimizing complications. These advancements are allowing patients to experience better outcomes with less disruption to their daily lives.

New experimental procedures are being developed, such as focal laser ablation and nanoparticle-based therapies for prostate and kidney cancers. Immunotherapy and gene therapy are also being integrated into surgical and post-surgical treatment plans to enhance effectiveness. Personalized medicine approaches are helping tailor surgical interventions to individual patient needs.

Each of these cancers requires a tailored approach to treatment, with procedures ranging from minimally invasive techniques to major surgeries. As medical technology advances, more precise and effective procedures are emerging, improving survival rates and quality of life for patients.  Please consult your physician to see what treatment plan would be best for you.