Radical Prostatectomy: From Open to Robotic PDF

Preface

The winds of change are blowing through the world of surgery for prostate cancer as never before. Open radical prostatectomy, once the gold standard treatment for localized adenocarcinoma of the prostate, is increasingly being challenged by the new technologies of laparoscopy and robotics. To complicate the issue further, other minimally invasive treatment options have emerged, including high-intensity focused ultrasound (HIFU), cryotherapy, and brachytherapy. Furthermore, conformal external beam radiotherapy (EBRT) allows higher doses of radiation to be delivered with greater accuracy to the prostate. Add to that the realization that in some low-risk cases treatment is unnecessary, and instead active surveillance may be the best option, and one can clearly see that there has never been a better time to review critically and in detail the art and science of prostate cancer surgery.

Many urologists believe that surgical removal of the prostate constitutes the best way to extirpate the malignancy and to resolve bladder outfl ow obstruction, but the issue of ‘collateral damage' to continence and erectile function has become a major issue. The argument now between the various proponents of the different forms of radical prostatectomy encompassed in this book is not so much about cancer clearance rates, which are all excellent, but in longer-term outcomes of continence, and especially sexual function. In the fi nal analysis, only carefully controlled and objective trials will provide us with the data we need to resolve this contentious issue.

In this book we have enlisted the world's leading experts to relate their own, very personal experiences of open, laparoscopic and robotically assisted radical prostatectomy, and the transition between them. We have also covered pre- and postoperative issues. We are most grateful to all of them for their hard work, timely manuscripts, and outstanding contributions. We would also like to thank the editorial and production staff at Informa, who have worked so tirelessly to make this book possible. Stateof- the-art information on radical prostate surgery is presented here, and we leave it to the reader, and to each and every one of their patients, to decide for themselves the best way forward for them.