Dear Dr. G,

I have been diagnosed with prostate cancer; this comes after I went for a routine PSA blood test at the age of 55 years old and ended up with a biopsy, which detected prostate cancer.

I was devastated after the diagnosis and was anxious with the subsequent MRI and Gleason grading and I guess I am lucky as the tests showed intermediate early-stage cancer.

As I am considered young, the urologist recommended surgery and explained that I may encounter erectile dysfunction and urinary incontinence after the intervention.

Although I am prepared to face the worst, I am still holding on to hope that I can preserve my urinary continence, erectile function and fertility.

I hear my hope lies with the helping hands of robotic surgery, and therefore would like to put Dr. G on the spot to shed some light.

Can you tell me why I have prostate cancer at such a young age, and why does the operation result in incontinence and impotence? Can it affect my fertility?

Also, how does robotic surgery help to minimize the complications?

Finally, is the incidence of prostate cancer on the rise?

Thank you in advance.

Yours truly,

Robotic Robert

Prostate cancer is a common cancer with the number of men diagnosed with it rising in many countries; it currently affects up to one in six men. Many attribute the rise in the diagnosis of prostate cancer due to the prevalence of diagnostic tests with PSA (Prostate Specific Antigen) and an overall increase in lifespans.

Although the cancer is generally associated with older men, the detection of the cancer in younger men is becoming more common. Such an observation is thought to be due to genetics and a sedentary lifestyle.

The primary function of the prostate gland is to secrete a slightly alkaline liquid called seminal fluid that helps to nurture sperm to facilitate fertility. The anatomical location of the prostate is also closely associated with the nerve and bloodsupply for the penis. Therefore, any intervention involving the prostate gland will often adversely affect a man’s sexual and reproductive health.

One of the most common methods for the complete eradication of prostate cancer is a radical prostatectomy. Such a surgical intervention is performed with open or keyhole approaches and in recent yearsm robotic-assisted removal of the prostate gland is carried out in order to minimize complications.

Before a radical prostatectomy, most men are counseled pre-operatively for potential complications such as urinary incontinence, erectile dysfunction and sterility. Although meticulous intra-operative care can be ensured to preserve the nerves responsible for continence and erections, this may not be

possible due to various stages of disease, the type of operation and the surgical experience.

Radical prostatectomies sever the connection between the testicle and the urethra, resulting in men unable to ejaculate naturally. As such, a man who has undergone a radical prostatectomies can experience an orgasm without ejaculation.

Although most men do not consider fertility an issue after the age of fifty, artificial reproductive technology (ART) now allows the direct retrieval of sperm from the source. Operations such as the PESA (Percutaneous Epididymal Sperm Aspiration), MESA (Microscopic Epididymal Sperm Aspiration) or TESE (Testicular Exploration and Sperm Extraction) can be carried out for men who

still wish to father a child after a radical prostatectomy.

When it comes to the robotic laparoscopic technique and its advantages, it allows surgeons to operate through small ports rather than large incisions, resulting in a shorter recovery time and fewer complications. The more advanced robots also provide 3D vision and surgical field magnification up to 15 times, improving the ability of the surgeon to recognize and control small blood vessels. This robotic technology means that surgeons are able to perform minimally invasive procedures with more precision. Robotic arms also remain steady at all times and robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles, positions surgeons would have difficulty reaching otherwise. The diagnosis of cancer is often unexpected and frightening, and the journey of

treatment and recovery may be plagued with disappointing outcomes, but advancements in space-age technology such as robotic surgery has helped many men to overcome fear and achieving a cure with a desirable outcome. Many men suffering from prostate cancer contemplating robotic surgery often put Dr. G put on the spot his for opinion. His view is that the unexpected diagnosis of prostate cancer begins with a journey of resilience; robotic surgery is often the helping hand to ensure sustainability of survival with minimal compromises in sexual health.

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