Prostate cancer: ‘For me, it was a silent disease – they were no symptoms’

Less pain, less dissection, less blood loss, less scarring – so why no robotic-assisted prostatectomies in the public health system?

It is not safe for you to assume that because you have no prostate urinary symptoms that you do not have prostate cancer

It is not safe for you to assume that because you have no prostate urinary symptoms that you do not have prostate cancer

 

The stats don’t bode well. One in seven men in Ireland will be diagnosed with prostate cancer during their lifetime. That’s over 3,300 diagnoses each year.

However, although it is (after skin cancer) the second most common cancer in men, most patients do not die from it. In fact, if caught early enough, it can be removed without any lasting negative side-effects.

“There’s a greater awareness of prostate cancer across all age groups now, so we’re fortunately picking it up at an earlier stage, meaning it’s more curable,” says Kiaran O’Malley, consultant urological surgeon at Dublin’s Mater Misericordiae and Mater Private hospitals, who adds that the cancer typically tends to affect men from their 40s upwards, though cases of younger patient diagnoses are also known.

O’Malley says there’s a far brighter public light shone on the cancer these days, including its symptoms and the value in catching and treating it early, whereas that hasn’t always been the case.

“Also, modern diagnostics have improved so much that we’re able to pick it up earlier and offer a range of various treatments for patients with early prostate cancer, so the outcome is excellent.”

One such modern treatment is robotic-assisted prostatectomy; a common operation in public health systems overseas, but off-limits in this first-world nation without private health insurance. The Mater Private Hospital has the largest robotic assisted surgery programme in Ireland, having performed the highest number of surgeries to date; nearly 2,000 surgeries since the hospital invested €2 million just over three years ago.

O’Malley has performed over 1,000 robotic assisted prostatectomy surgeries, making him the most experienced “robotics” surgeon in Ireland.

The result? Typically, less pain, less dissection, less blood loss, less scarring and less time spent in hospital

“It’s minimally invasive surgery,” says O’Malley. “A robot is remotely controlled by the operating surgeon sitting at a console, using finger-controls called Endo Wrists and pedals. It gives a high-definition, magnified view through the console’s eye-holes, which gives us the exact same view that we would get at open surgery, only magnified, with the instruments being much smaller than those used in either non-robotic keyhole surgery or open surgery.”

The result? Typically, less pain, less dissection, less blood loss, less scarring and less time spent in hospital – as well as quicker recovery times for patients. So, if the results are so standout, why is there no robotic-assisted prostatectomies available in the public system in Ireland?

Much inequity in the system

“It all boils down to cost; management are resisting it based on the fact that there is no concrete, head-to-head data that shows that robotics is superior to open surgery,” says O’Malley.

“But we don’t have a head-to-head trial that shows, for example, keyhole removal of the gallbladder is better than open removal of the gallbladder, but the world knows that this is the case.”

At prostate cancer international meetings now, open surgery is not even mentioned

But while the final outcomes of both open and robotic-assisted prostatectomy are very similar, such results say nothing of the differing impact each have – in the interim – on pain, time and cost, for the patient, his family, the nation’s health service and economy: two nights spent in hospital for robotic surgery, compared to up to a week for open surgery; patients have a catheter in their bladder for three weeks after open surgery, compared to one week after robotic surgery, while they’re back to work weeks after robotic surgery, compared to about three months after open surgery.

“Robotics is the gold standard internationally, to the extent that open surgery is not even being taught to young trainees elsewhere. At any of the prostate cancer international meetings now, open surgery is not even mentioned,” says O’Malley.

“Unfortunately, until there is a loosening of the purse strings at the Department of Health, we’re going to continue having this lopsided situation: public patients are being denied access to a service private patients can have. There’s much inequity in the system.”

Get checked: it’s a no-brainer

“My operation took two hours; I was in hospital for two days and was back exercising within two months. I have not looked back since,” says David McMahon of his robotic-assisted prostatectomy in the Mater Private Hospital.

“At least in my own experience, it has to be among the easier cancer cases, but it goes to show the huge importance of early detection.”

A 48-year-old husband and father of two, in 2015 McMahon and a colleague went for a routine executive health check. The only concern raised in the results was a slightly-elevated PSA (prostate-specific antigen) level in his blood, which was consequently retested over the following months.

Following further increases in his PSA, biopsy results later confirmed he had prostate cancer.

Fortunately, McMahon didn’t experience any of the negative side effects sometimes associated with a prostatectomy, such as erectile dysfunction and incontinence.

“I just have three very small scars around my lower abdomen – you wouldn’t even notice them unless looking for them. For me, it was a silent disease – they were no symptoms really, as far as I knew. I was very lucky: I was 46 and it was very early stage, because of which I had various treatment options.

I don’t feel deserving of the tag, ‘cancer survivor’

“I got much advice and opted for a robotic-assisted prostatectomy. Because it was so early stage they were able to remove the prostrate and spare all the nerves, so I thankfully had none of the associated side-effects,” says McMahon.

“When people ask about the cancer I had, there’s a part of me that feels like a cheat because I know what other people go through with different types of cancers. To be honest, I don’t feel deserving of the tag, ‘cancer survivor’ because what I went through is absolutely nothing in comparison to what most cancer patients have to endure . . . I would urge men to go off and get checked. It’s a no-brainer.”

Understanding prostate urinary symptoms

According to the Irish Cancer Society, problems passing urine is a common complaint for men as they grow older.

Symptoms may include: a slow flow of urine; trouble starting or stopping the flow; passing urine more often, especially at night; pain when passing urine; blood in the urine or semen; feeling of not emptying your bladder fully. These symptoms may be caused by prostate cancer or they may be caused by other conditions, such as a benign growth of the prostate gland.

The Society stresses that early prostate cancer may not cause urinary symptoms, or any symptoms at all, so it is not safe for you to assume that because you have no prostate urinary symptoms that you do not have prostate cancer.

Visit your doctor and get checked, and also see cancer.ie.

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