Robotic Partial Nephrectomy for Kidney Tumours

The backbone remains continuous ADT, agents like degarelix or leuprolide, combined with newer anti-androgens such as abiraterone or enzalutamide, known as ARPIs (androgen receptor pathway inhibitors), plus genetic testing, where a BRCA mutation supports adding a PARP inhibitor such as olaparib, with many patients now on doublet, triplet or even quadruplet combinations rather than ADT alone. Oligometastatic (limited stage 4) disease confined mainly to the prostate and pelvis can still be surgically debulked alongside roughly one to one-and-a-half years of ADT; widespread stage 4 disease has no surgical indication. When these lines of treatment fail, options include immunotherapy, docetaxel- or paclitaxel-based chemotherapy, and lutetium (PSMA) radioligand therapy, which tags rapidly-dividing, PSMA-expressing tumour cells for targeted internal radiotherapy, plus other immunotherapies such as pembrolizumab. Targeted gene therapy itself isn't yet in commercial clinical use, what is used is genetic testing to select the most effective molecule for a given patient's mutation profile, such as PARP inhibitors for BRCA2-positive cancer.

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.

Removing a kidney tumour while preserving the healthy part of the kidney (nephron-sparing), important for patients with bilateral tumours or at risk of needing dialysis if a whole kidney were removed.

Yes - there is about a 4% chance of a new kidney tumour developing later in the same or the other kidney, sometimes requiring a second partial nephrectomy.