Robotic prostatectomy: a patient's perspective
– Charlie Blackwell

Charlie Blackwell is an active 58-year-old who had a robotic prostatectomy in August 2010. Mr Blackwell describes his experience of prostate cancer diagnosis, treatment and surgery. He was treated locally until choosing to come to Harley Street Urology for a second opinion. Mr Blackwell had a specialist da Vinci prostatectomy surgery undertaken by consultant urologist Marc Laniado.

“In retrospect, I consider that in the public domain (TV, newspapers/men's magazines/internet exposure) prostate cancer awareness urgently requires increasing publicity (which the various fine cancer charities always strive hard for) as it is so poorly understood by most men, and diagnosis therefore left unwittingly to chance. I happened to have a BUPA men’s MOT health check every two or three years, which includes a PSA blood test. When my results showed my PSA, at a steady level for years, had moved up from 6 to 7.6, I was referred to a local urologist by BUPA on their recommendation as a security precaution.

“From a patient’s perspective, it is very bewildering scenario. I had a local examination, followed by a biopsy, which was inconclusive but suggested a moderate grading, then an MRI scan which was clear in showing the tumour to be ‘contained’, and lastly a nuclear bone scan which confirmed the containment within my prostate. The urologist suggested, with my agreement, active monitoring, which meant having a PSA test every six months and waiting before any required treatment takes place should evidence change. You therefore know you have a cancerous tumour within your body and almost inevitably at some stage, you will have to do something about it. Although some prostate cancers are notoriously slow growing, I felt unconvinced about this approach but accepted the urologist’s advice as the professional involved.

“Two years later, when my PSA jumped up to 9.8, the urologist whisked me in and said straight away that it was time to take out my prostate. He read off the different treatment options like a shopping list and told me to go away and think about it. I was unimpressed and felt immediately there is was too little one-on-one direct guidance for patients at the outset about making such an important and possibly life changing decision. You are left in limbo. My consultant urologist’s appointment, which resulted in being recommended to undergo major surgery, lasted less than 20 minutes and the shock was only somewhat negated by already having known for two years that a potential problem existed.

“Like so many people, I went onto the internet at length to search for information. I also contacted my excellent local GP who told me he had never had a patient with prostate problems who had gone through such rigorous personal research! I also importantly asked a great friend who is a surgeon for his advice. He told me to consider very carefully whether surgery was necessary and if it was, to look for the least invasive option. Through my own very detailed research I was able to target specifics which in my case was treatment for locally advanced but still fairly contained cancer. I deduced eventually that robotic surgery seemed an obvious option and contacted Harley Street Urology for a second opinion.

“I felt it a priority to politely ask how many procedures Mr Laniado had completed using the da Vinci robot. It would seem that there are a great many urologists attached to the NHS who only carry out relatively few (say six to 10) operations a year, be it radical surgery, laparoscopic etc. It seems very obvious that a surgeon who only does six or seven operations a year will not have the same results as a surgeon experienced in hundreds. The after effects of a prostate operation – the possibility of either incontinence or sexual dysfunction – almost entirely depend on the skill of the surgeon involved rather than any external factors. The Da Vinci robot, which is a relatively new process, reassuringly requires a very high degree of training and expertise to operate with, and I was thrilled to learn that Mr Laniado was part of the third team in the UK to start using the robot several years ago and that he had successfully completed a large number of operations.

“I was also particularly impressed with Mr Laniado when I met him. He was honest and clear with me about my treatment: there was a good chance that the prostatectomy may be sufficient, but he made it quite clear I could need further radiotherapy if any of the rogue cancer cells had ‘escaped’ and this could not be quantified until there was a post-surgery biopsy on my prostate and any further imbalance showing in my future PSA tests. If I chose to start treatment with radiotherapy instead, surgery would not be possible as a second stage treatment.

“I felt very anxious about surgery. If you are facing prostate surgery at my age, as many men are, your perceptions of surgery tend to be shaped by historic experiences of surgery in the last century! At that time, you saw parents and friends going through operations which were painful, invasive and demanded considerable hospitalisation then lengthy recovery. And of course, the old anaesthetic drugs and techniques left patients feeling groggy for weeks. I had little or no knowledge of the vast technological advances in non-invasive surgery on both sides of the Atlantic. Having planned the operation with Mr Laniado for August, my wife and I made no plans for September and I expected to be struggling slowly down the stairs using a walking stick for weeks probably pissing everywhere!

“The reality was completely different. I had my operation on the Saturday, felt a little groggy on the Sunday, better by Monday and fine on Tuesday when I returned home. Unbelievably to me, there had been no post operative pain whatsoever. The catheter of course took some getting used to and the immediate lack of bowel movements was obvious for the first three days. The difference with modern anaesthesia was astonishing. I suffered no post operative grogginess. Mobility only seemed difficult for 24-48 hours mainly as I was acutely aware mentally of having undergone a major four hour operation. There were no gaping wounds from a large incision. I just have four tiny scars where the instruments were inserted to reach my prostate. I felt keen to exercise again on returning home and asked Mr Laniado if it was safe to do so without causing damage. He told me there was almost nothing to damage. Needless to say I felt I had to be a little careful initially and self preservation kicked in!

“My catheter was removed ten days after surgery. It had proven very manageable once I understood the mechanics and kept a check on the leg strap. One joy was being able to shower daily with no difficulty.

“Fear of incontinence raises its head pretty quickly and it was a real concern for me. I’d done my pelvic floor exercises very carefully and meticulously to prepare before surgery.

“On the first night after removal, I had to get up every two hours to go to the loo. But it got better very quickly, reducing to once a night and during the day I’m getting better in leaps and bounds with careful but ever lessening use of incontinence pads less than a month since surgery. Even this delicate area looks like presenting no future problems and I put this entirely down to the skill of Mark Laniado’s surgery. This is an area where the precision of robotic surgery is so important; the margins between the prostate and the bladder are small, so it is vital that the surgeon is highly experienced and the technique is as exacting as possible.

“As for any erectile dysfunction or similar problems, it is still too early in the day to be able to report on this – I am hopeful, despite having had some of the associated nerves removed, and at worst I have some very good bedside reading to catch up on!

“The lab tests showed my prostate cancer was extremely virulent and it may have minimally breached the wall of the prostate. I don’t know at this stage whether I will need to have radiotherapy, but all the signs are good, and fear of any future treatment is not of a worry to me at all at present, as the major cause has been successfully removed forever. The fact is that without my regular MOTs, I could have developed an incurable bone cancer and all associated major problems with radically different and impairing treatment options and a rather shorter time horizon facing both myself and my family. I am truly grateful.

“It is unfortunately a medical fact that if you do not receive an early warning of prostate cancer, then potentially you could eventually be facing real trouble. I had no outward signs at all that I had this problem, only a random health check flagged this up. Yet most men are so very reluctant to go to the doctor or to think about their health. Women are far more sensible when you compare their approach to breast cancer with men’s awareness of prostate cancer.

“I would urge men to have regular PSA tests and see their doctor even if they have no obvious concerns at all. One simple blood test for PSA annually after say 50 years old takes less than two minutes! If you do find yourself facing a prostate cancer diagnosis, I would advise everyone to actively look at the all different options on the recognised cancer and charity websites (Prostate Cancer Charity, Macmillan, UK Prostate Cancer Link etc) and also get the benefit of a second opinion. For me personally, robot-assisted surgery was an excellent option and surgery was instinctively the right option. I was staggered by the new technology and its lack of invasiveness.

“At the end of the day it all comes down to maintaining a positive attitude, listening attentively to the expert advice available, and continuing to chase after a good quality of life.”

Find out more

▸ Read more about the Da Vinci (robot-assisted) prostatectomy
▸ Find out more about the causes and symptoms of prostate cancer