Alright Dr. Scholz, so our next topic is robotic surgery, and a lot of people want to know
what the process is and what your opinion is on it.
So, robotic surgeries replaced the older methods where, unfortunately, men had a big scar that
went from their sternum all the way down to their pubic bone and the doctors needed that
kind of exposure because they had to get their hands deep into the pelvis, move the bladder
aside, and then do all kinds of little microsurgery, you know, cut the urethra (the passageway
that the urine goes from the bladder through the prostate and out the penis), and that
all being accomplished in oftentimes problems with bleeding and things that would obscure
visual access to the area. So, what's the issue with robotic surgery? So, I think around
2004, 2005 the Da Vinci company came up with an idea for operating remotely using little
pinchers which were on robotic arms that could go into much smaller incisions, so you didn't
have to open up the whole tummy to get to the prostate area, and then using magnification
and bright lights inside these little robotic arms could kind of sneak around and, obviously
a more efficient way to handle the very tight anatomy of the pelvis. And there was a lot
of initial excitement about the possibilities that this would improve cure rates, that it
would reduce the incidence of impotence and reduce the incidence of incontinence. Unfortunately,
after many studies and comparative evaluations, it did none of that. The incidence of impotence,
incontinence, and cure rates is identical with old-fashioned surgery and the newer robotic
approach—which now, these days, almost everyone gets robotic surgery.
So, are there any advantages to doing robotic surgery compared to the older methods? And
the answer is yes. When you cut a gigantic incision from your sternum to your pubic bone,
that's a major invasive insult to the body and in those days it would take anywhere from
1-3 weeks to recover from that operation. With the robotic surgery and the smaller incisions,
people are going home from the hospital much more quickly and the recovery is much faster.
The ultimate outcomes, though, the long term outcomes in terms of cure rates, impotence
rates, and control of urinary function is unchanged which, in my view, is a big disappointment.
When robotic surgery first came out, the radiation world was pretty backwards and there were
a lot of men that were getting rectal burns and the radiation wasn't powerful enough to
cure people. But, what has changed in the last 15 years—robot surgery stayed about
the same—but radiation technology has improved immensely and now, as of 2020, I rarely even
consider surgery as an option for men with newly diagnosed prostate cancer.
I'm really glad you spoke to that because I think robotic surgery is marketed heavily
that it's going to have better cure rates than the old-fashioned non-robotic surgery.
So, are there clinical studies comparing radiation and surgery?
There are actually clinical trials arguing that surgery has better cure rates but in
those clinical trials they didn't point out that the men getting surgery are 10-15 years
younger than the men getting the radiation and the men getting surgery have earlier,
easier to treat disease. So, it's not really an apple versus apple comparison. Yeah, the
surgery industry is a multi-billion dollar industry, very strong, and there's a lot of
momentum because 10-15 years ago the radiation was certainly inferior and surgery had the
whole world by the tail. It was the way to go. But, things change quickly in this modern
era. Technology changes with better computers, better targeting. The non-invasive radiation
options are causing far less damage and they're easily replicating the surgical cure rates now.
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