Robotic prostatectomy: a patient's perspective –
Simon Dolan

Simon Dolan from Hertfordshire, was 49 when he was diagnosed with prostate cancer using enhanced MRI, also known as prostate mapping. Simon, who is a scientist, describes why he elected for robotic assisted surgery and his experiences with the da Vinci system.

“Three years ago, I had a sudden onset of pelvic pain and was getting up to go to the toilet every hour all through the night. It only took a few days to build up and developed very quickly, so I saw my GP. I had a PSA test, which was 3.4ng/ml. and was prescribed medication which stopped the urge to get up at night. I was referred to Marc Laniado.

“Initially, I wanted to avoid having a biopsy if possible. So one of the things I really liked about Marc was his enthusiasm for and knowledge of new technology within the field of prostate cancer. As a scientist, this was important to me, particularly as there have been so many developments in prostate cancer management since I was first referred to Marc. I had a number of PCA3 tests and my scores were low. I also had prostate ultrasound which did not reveal anything abnormal, but my PSA was slowly rising and by the autumn of 2010, it had reached 5.1.

“At that point, Marc suggested I had a new type of assessment called an enhanced MRI scan, or prostate mapping with Dr Clare Allen, a radiologist well known for her work in prostate cancer. The scan revealed there was an abnormality there which was likely to be prostate cancer. It also showed, thankfully, that it seemed to be confined within the prostate. A biopsy confirmed that diagnosis, Gleason score of six.

“My initial instinct was to have my prostate removed. However, Marc suggested I should have a second opinion and see an oncologist. I was pleased to have considered the different options, but for me personally, going for surgery always seemed the best option. First of all, if for any reason a prostatectomy didn’t work, I wanted to have the option of a second line of treatment with radiotherapy, whereas that would not be available if I was treated with radiotherapy first. I was also aware that radiotherapy increases the risk of bowel cancer in the longer term and was concerned about that because I am relatively young and bowel cancer runs in our family. I didn’t like the idea of hormone therapy because of potential impact on bone density. Finally, surgery offered a cleaner outcome with a better assessment of the extent of the cancer possible on subsequent examination of the prostate.

“There was of course a flip side to the benefits of surgery. Survival is the overriding concern, but I was concerned too about being continent after surgery and being able to have a normal sex life. Marc explained that robot-assisted surgery affords a high degree of accuracy in terms of the dissection of the nerves which lie around the prostate and the removal of any trace cancer cells. I was assured by the fact that Marc performs this sort of surgery on a very regular basis because surgeon skill and experience is clearly important.

“I had my operation on November 27, 2010. Nothing can prepare you for how you feel as you are wheeled into the operating theatre but when I came round, I felt pretty good. There was no blood loss, no discharge and no real pain to speak of. I managed perfectly well just taking some paracetamol to help with any discomfort and returned home within two days of surgery. I was really impressed at the difference between the minimally invasive approach used in my prostate operation, compared with previous operations I’d had which were really painful. In fact, looking back, I found the biopsy more uncomfortable than the surgery.

“For the first two weeks after surgery, I simply laid low. Fortunately, this was during the Ashes, so that helped! I was dry instantly upon removal of the catheter– I had no problem whatsoever with incontinence. Marc suggested I took a low dose of Cialis to help the repair mechanism for erectile function, but I didn’t really need it and was able to have sex again without any difficulties fairly soon after my surgery. I am a swimmer and was back in the pool three weeks after the operation and I think the movement of the muscles in swimming really helped to speed up the recovery process. My cancer was contained although the Gleason score was revised upwards to seven. When I had a PSA test three months after surgery, my result was the optimal less than 0.01ng/ml. It is all looking positive now but you never know with cancer so I’m not celebrating yet.

“There is often a lot of uncertainty surrounding prostate cancer diagnosis; you face many false positives and false negatives. As such I have really valued Marc’s ability during the past three years with his logical approach, persistence and explanations on the various options and I have always felt this was a partnership. He is also very flexible with his consultations. For example, I live in Hertfordshire, so rather than always travelling to see Marc for appointments, in some cases he has offered consultations via the phone and email, which is much more convenient for me. I was also impressed that he is surrounded by an excellent team and encourages patients to seek a second opinion.

“My advice for anyone experiencing concerns about their PSA or a prostate cancer diagnosis would be to read up on the subject and be as informed as possible, but be very careful not to over interpret the data as each case is unique. Stay positive, if your cancer is fully contained then the chances are very good that you will be cured. When you are considering treatment, make sure you get a second opinion so you can be sure to have explored all the possible options. Finally – don’t wait. If you have urinary symptoms or any pain, don’t put it off, make sure you go to your GP as soon as you can and have a PSA test.”

Find out more

▸ Robot Assisted Prostatectomy
▸ Prostate cancer
▸ The PSA Test