This is one of the most common questions that patients ask me, especially if the cancer is confined to one area on biopsy.
With robotic surgery I am able to remove part of a prostate if I want to, and I often do that for BPH operations.
For prostate cancer it is not the correct thing to do. The prostate is made up of an inner part that usually grows and causes BPH and the outer, peripheral part that is usually where the cancer starts. Once you have cancer in one area, it is likely to be in several areas. All prostate glands are at risk for developing into new cancers. I recently presented an abstract at the prostate cancer symposium in Orlando entitled:
Extent of prostate cancer in patients presenting with presumed minimal tumor burden.
This was a study I did by looking at my robotic prostatectomy database. I found patients that only had 1 area of gleason 6 cancer and a PSA of less than 10. The results and conclusions were as follows:
On radical prostatectomy, all cancers were organ confined and 34 of 35 cancers showed negative margins. Despite having been selected for presumed minimal tumor burden, the majority of the cases were found to be multifocal (24 cases or 69%). The pathological stage based on final pathology was most commonly T2c reflecting bilateral disease (26 cases or 74%), while the remaining 9 cases (26%) were at T2a. Lymph nodes were not assessed on these patients. The Gleason’s score was upgraded to 7 in 4 patients and to 8 in 1 patient. Tumor volume was > 2 cc in 14 patients and > 5 cc in 2 patients.
Conclusions: Although prostate cancer is often diagnosed early, physicians should understand that it is difficult to predict solitary lesions based on needle core biopsy and PSA value. Our results suggest that prostate cancers are frequently multifocal and bilateral, and should be managed as such. Focused therapy that targets only a portion of the prostate gland may not be adequate for long term cancer control.
My main reason for doing the study was to show that I did not think treating part of the prostate by freezing or ultrasound was a good therapy from a cancer control standpoint.
The operation that I do currently is the same as what I did when I did open the open radical prostatectomy: I remove the prostate in its entirety, seminal vesicles, part of the vas deferens, and the pelvic lymph nodes for staging.
The main log term side effects are sexual, which I have discussed previously.
The other side effects are urinary leakage which usually gets back to normal with a better flow.