W ITH benefits such as minimal pain, reduced blood loss, smaller scars, and shorter hospital stays, a local doctor is offering laparoscopic radical prostatectomy as a surgical option for men with localised prostate cancer in Jamaica.
Traditionally, open radical prostatectomy or radiation are the other treatment options used.
The open surgery, which consultant urologist Dr Roy McGregor says may be quicker, involves making a cut in the abdomen to give the surgeon access to the prostate, while the laparoscopic version is minimally invasive, so small incisions are made to allow access for surgical instruments and a thin telescope that magnifies the image onto a television screen. The urologist said, as a result, patients recover quicker after the laparoscopic surgery and go home earlier.
“Also, whereas before, people presented later and would be worried about prostate cancer surgery because of the pain, blood loss, incontinence, and loss of erectile function, nowadays, if you catch it early, you can prevent and preserve all of these aspects,” consultant urologist Dr Roy McGregor told the Jamaica Observer in a recent interview, adding that this is possible with either the open or laparoscopic surgery.
“In medical terms, we call it a trifecta, which is cancer cure, potency preservation and continence,” he said.
The urologist said, too, that with laparoscopic prostate cancer surgery, scars are less visible, patients are up and about within 24 hours of the procedure — requiring few painkillers — and usually go home after two or three nights in hospital. Dr McGregor also said that patients are less likely to get clots in the legs that can then be dislodged to the lungs.
“They don’t have a big wound so they are less likely to get immobility-related problems such as pneumonia, because coughing to clear the lungs is less painful after laparoscopic surgery,” he continued.
In fact, the laparoscopic approach, which Dr McGregor performs at Cornwall Regional Hospital, Andrews Memorial Hospital and Tony Thwaites Wing of The University Hospital of the West Indies, is currently finding favour among patients of the Jehovah’s Witnesses faith.
“They are referred because their faith prevents them from having blood transfusions. Of the cases done so far, none of the patients required intra-operative blood transfusion,” Dr McGregor disclosed.
After training in the United Kingdom and Australia, Dr McGregor returned to Jamaica in 2009 and started offering the prostate cancer surgery at Cornwall Regional Hospital under the guidance of internationally recognised expert Professor Chris Eden, who performed the first-ever laparoscopic radical prostatectomy in the United Kingdom in 2000, according to the consultant urologist.
He told Your Health Your Wealth that, having achieved excellent results, he wants Jamaicans, at home and abroad to know that laparoscopic prostate cancer surgery can be accessed locally.
“My patients have been encouraging me to let people know, because most persons don’t realise that it is available in Jamaica and people are having to travel overseas and pay an arm and a leg for robotic surgery, when they can get laparoscopic treatment here. Laparoscopic radical prostatectomy is routinely performed overseas and is like robotic surgery, but at a fraction of the cost,“ he explained.
Dr McGregor went on to describe the candidate who would be eligible for this surgery.
“Anybody with localised prostate cancer that has not spread, with a life expectancy of greater than 10 years, could have laparoscopic surgery. Prostate cancer patients are categorised into low-, intermediate- and high-risk groups, with intermediate and high-risk diagnosis needing treatment in the form of radiotherapy or surgery,” Dr McGregor said.
The consultant urologist told Your Health Your Wealth that 81 per cent of his patients were in the high or intermediate-risk groups. For these patients, he said he also removed the lymph nodes in the pelvis that drain from the prostate and trap cancer cells, before they spread further.
Dr McGregor said studies have shown that the more pelvic lymph nodes removed, the higher the likelihood of remitting the cancer.
The doctor shared that when he first returned to Jamaica, he saw a lot of patients with advanced disease that had already spread and was, therefore, not treatable. He said these patients were not candidates for surgical intervention.
However, the urologist said he is now seeing fewer people presenting with late disease, which is an indication that the disease is being diagnosed in the early stages when it is still curable. This, he said, is probably partly due to the screening and prostate cancer awareness work being done by the Jamaica Cancer Society and other groups.
Explaining further, Dr McGregor said: “The thing about prostate cancer is, as long as you catch it early and treat the whole prostate and lymph nodes before it has spread further, you’ve cured it.”
“So, it is important that men over 40 years old get screened, especially if they have a family member with prostate cancer,” he continued.
According to the consultant urologist, Jamaica has one of the highest incidence of prostate cancer in the world. It is the most common cancer in men, he said.