Why Robotic Prostatectomy is Superior to Radiotherapy, Brachytherapy, and Focal Treatments for Prostate Cancer

Prostate cancer is one of the most common cancers affecting men worldwide, and selecting the most appropriate treatment can significantly impact outcomes, quality of life, and long-term health. Among the available options, robotic prostatectomy, a minimally invasive surgical approach, stands out as a superior choice for several compelling reasons, especially when compared to radiotherapy, brachytherapy, and focal treatments.

1. Surgical Certainty: Accurate Staging and Grading

Robotic prostatectomy offers unparalleled clarity in understanding the true nature of the cancer. During surgery, the entire prostate gland and seminal vesicles are removed and examined by a pathologist. This comprehensive analysis provides definitive information about the grade and stage of the cancer.

Studies show that in up to 30% of cases, biopsy results understate the aggressiveness of the cancer, and the post-surgical pathology reveals a higher-grade disease. This upgrade in diagnosis can dramatically influence the next steps in management, allowing for tailored adjuvant treatments, if needed.

In contrast, non-surgical treatments like radiotherapy, brachytherapy, and focal therapies do not provide this level of certainty, leaving patients at risk of undertreatment or overtreatment based on incomplete information.

2. Lower Risk of Secondary Tumours

Radiotherapy and brachytherapy, while effective in some cases, carry a long-term risk of inducing secondary cancers in the surrounding tissues. Studies indicate that 5–10% of patients treated with these modalities may develop secondary cancers in the rectum or bladder within 10 to 15 years of treatment. This risk arises from the exposure of healthy tissues to radiation.

Robotic prostatectomy eliminates this concern as it is a targeted surgical approach that does not involve radiation exposure, ensuring the surrounding organs remain unaffected.

3. Easier Management of Recurrence

Cancer recurrence is always a possibility, regardless of the initial treatment. However, the ability to effectively manage a recurrence varies significantly between treatment modalities:

· After robotic prostatectomy, recurrence can often be successfully treated with radiotherapy, ensuring a robust second line of defence.

· Conversely, recurrence following radiotherapy, brachytherapy, or focal treatments presents a significant challenge. Salvage surgery after these modalities is technically possible but comes with poor functional outcomes, particularly regarding continence and erectile function. The scarring and tissue changes caused by radiation make nerve preservation nearly impossible, severely impacting quality of life.

4. No Need for Hormonal Treatment

Robotic prostatectomy typically eliminates the need for hormonal therapy as part of the initial treatment, which is often required in conjunction with radiotherapy or brachytherapy. Hormonal therapy induces andropause, a condition similar to menopause, with significant side effects, including:

• Fatigue
• Hot flushes
• Loss of libido
• Depression
• Osteoporosis
• Metabolic changes, such as weight gain and diabetes risk

By avoiding hormonal therapy, robotic prostatectomy spares men from these debilitating effects, preserving their overall health and well-being.

5. Lower Recurrence Rates than Focal Therapy

Focal treatments, such as High-Intensity Focused Ultrasound (HIFU) or cryotherapy, aim to treat only the cancerous portion of the prostate, sparing the rest of the gland. While appealing in theory, these treatments have significantly higher recurrence rates, often necessitating additional interventions. Furthermore, if cancer recurs after focal therapy, salvage surgery or radiotherapy is fraught with complications and poorer functional outcomes.

6. Minimally Invasive and Highly Precise

Robotic prostatectomy, performed using advanced robotic systems, is a minimally invasive procedure that offers:

· Smaller incisions

· Reduced blood loss

· Faster recovery times

· Superior precision, enabling nerve-sparing techniques to preserve erectile function and continence

Patients often return to normal activities within weeks, and the advanced visualisation and dexterity of robotic systems allow surgeons to achieve exceptional oncological and functional outcomes.

7. Psychological Peace of Mind

Undergoing robotic prostatectomy provides many men with a sense of closure, knowing that the cancerous organ has been entirely removed. This certainty can alleviate the anxiety associated with living with a treated but intact prostate, which can be a concern with focal therapy or radiotherapy.