Managing Prostate and Kidney Cancer Without Access to Robotic Surgery

The patient needs a realistic sense of hope appropriate to their stage. A PSA above 1000 indicates metastatic disease, and in that setting the approach shifts from surgical cure to bringing the cancer under control with ADT and other systemic molecules.

Transurethral procedures such as bipolar enucleation, bipolar resection, TURP, or HoLEP are all for benign prostate enlargement. Radical prostatectomy is a different operation for cancer of the prostate, done robotically. There is also a robotic option for very large benign glands: whenever the prostate is bigger than 200 to 250 grams, a robotic simple prostatectomy is performed instead of a transurethral procedure.

Outcomes vary by patient. In one case, a patient in his early sixties found to have a Gleason 4+4 tumour during routine follow-up for an unrelated condition could not be kept on active surveillance despite being young and sexually active. Given a realistic estimate of about an 80% chance of good erections afterward, he was started on tadalafil to prime the tissue before robotic surgery; within about four weeks of catheter removal he reported a full return of intimacy with his wife. Preservation depends on how sexually active and physically strong the patient was beforehand and on the tumour stage: early-stage tumours allow both neurovascular bundles to be spared, with tadalafil and, if needed, self-stimulation techniques or intracavernosal injections used during rehabilitation; in advanced cases where nerves cannot be spared, a penile implant remains an option. Cancer cure always comes first, since the patient must survive before sexual function can be addressed.

It varies by surgery, patient and condition, recovery can be as early as 4 to 6 weeks, sometimes 3 months, sometimes a year, and it may or may not return at all, depending on multiple contributing factors. In the prostate cancer trifecta used to counsel patients, cancer control comes first, urinary control second, and sexual control third.

Prostate cancer is usually multifocal, so focal therapy only suits a small subset of patients, about 2 to 5% of the whole pool, where a complete systematic biopsy confirms one localised, well-circumscribed nodule with the rest of the gland genuinely tumour-free; this treatment is available in India when that scenario applies. Because most prostate cancer is multifocal, robotic surgery remains the treatment of choice, with a time-proven cure rate of roughly 95%. Focal therapy treats one spot, but a new nodule can appear elsewhere later, and prior radiotherapy or focal therapy makes a subsequent robotic surgery more difficult and reduces the chance of preserving nerves and sexual function, so focal therapy is not an alternative to robotic surgery, just a different treatment for a different kind of patient.

No - it causes more harm than benefit and leaves the patient without erections, while the disease may still progress; it should only be considered once metastasis is confirmed, for example via a lumbar spine and pelvis MRI where bone or PET scans aren't available.

Yes, if disease is confined to the kidney and IVC - nephrectomy with IVC thrombectomy is appropriate - but once there are multiple distant metastases, surgery no longer helps and systemic treatment (immunotherapy or TKIs) is the priority.