Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice. 

Evo Terra (Host): Prostate surgery isn't something any man looks forward to, but advances in medicine can help alleviate and assuage many concerns. Let's find out how robotic surgery is doing so for prostate cancer patients with Dr. Kyle Schuyler, a urologist at Skagit Regional Health. 

This is Be Well with Skagit Regional Health. I'm Evo Terra. Dr. Schuyler, thanks for joining me today. Before we get into the fun talk about robots, let's start from the beginning. Can you explain what prostate cancer is and how it typically develops?

Dr. Kyle Schuyler: Yeah. So, prostate cancer, as the title denotes, is cancer of the prostate, which is an organ that sits in the pelvis of a male, kind of sits below the bladder and surrounds the urethra like a doughnut. So, regarding prostate cancer, it's the most common internal malignancy in men in the United States. So, by internal, I mean things are excluded like skin cancer.

Interestingly, it's also the second leading cause of cancer-related death to men in the United States. So, it's an important topic. It typically kind of presents in men in their 60s or older. And with that being said, it can happen at any age. About 20-50% of men within their 50s can have prostate cancer. So, it's a pretty common cancer.

Evo Terra (Host): What are some symptoms of prostate cancer? And how is it usually diagnosed?

Dr. Kyle Schuyler: Interestingly, prostate cancer is usually asymptomatic. It doesn't have any symptoms. The concerning part about prostate cancer is as it's developing and kind of spreading, that's when it becomes symptomatic. So, kind of late in the process, it'll become symptomatic with bone pain or blood in the urine. It can block your urinary stream. It can block your kidneys. That leads to the screening process, which is pretty important for prostate cancer to catch up early. So usually, that involves just a PSA, which is just a blood test, and a prostate exam, which is a quick rectal exam. 

And in the men undergoing prostate screening routinely, usually through their primary care doctor, about 90% of prostate cancer is found to be organ-confined at diagnosis, which is why the screening process is so important.

Evo Terra (Host): And the screening process is important for everyone. I say this speaking from personal experience. Yes, you want to get your screening done. But for those that aren't yet convinced by my words, what are the risk factors that come along with developing prostate cancer? And what should we be doing other than getting a screening?

Dr. Kyle Schuyler: Yeah. So, screening has been a little bit controversial and kind of publicized. People sway away from it, including primary care doctors. As for those who should be screened, it is most men from the age of about 50 to 70. There are some caveats to that. If you have a family history, you should start a little bit younger, typically 40 to 45. And as for risk factors that contribute to prostate cancer, one is family history, obviously. African Americans are more likely to have prostate cancer and also tend to have more aggressive prostate cancer. As I previously mentioned, age too, so age greater than 40 or 50 years old. And then, there's some genetic mutations, which we won't necessarily get into, but there are some genetic mutations that make you at a higher risk, not only for prostate cancer, but most often other cancers as well.

Evo Terra (Host): Okay. Okay. Great. I know we want to get in talking about robots very, very soon. But before we jump in there, I want to talk about the different treatment options that are available if you are diagnosed with prostate cancer. And I'm assuming there is some variation depending on the stage of the disease, yes?

Dr. Kyle Schuyler: Yeah. It's very important. So, within localized prostate cancer, so cancer that's just within the prostate itself, we typically manage it in four different ways. One is called watchful waiting, which is doing nothing. Not doing PSAs, prostate exams, kind of forgetting that the diagnosis is even made. The whole reason that's even an option is, every once in a while, we accidentally diagnose prostate cancer in very unhealthy and/or elderly men. And if that's the case, something else is going to happen before the prostate cancer causes any issues. That's the watchful waiting crew. 

Another option would be active surveillance. So, with low-risk prostate cancer in certain situations, you can just watch it. You get PSAs every once in a while. You get prostate exams every once in a while. And some repeat prostate biopsies and prostate MRIs. With those low-risk people, when done in the appropriate setting, only about one-third ever move on to some sort of treatment, and two-thirds can be watched indefinitely. So, they kind of avoid all the risks of treatment, while still being able to watch closely throughout their aging process. And then, we come down to actual treatment options. One is generally surgery, and we'll get into that a little bit more, and the other is radiation.

Evo Terra (Host): Now, I know that Skagit Regional Health now is offering robotic surgery for prostate cancer. Can you explain how the robot helps you in the surgery for prostate cancer? What it entails and how is it different than, I guess, the old-fashioned way, minus robots? 

Dr. Kyle Schuyler: Yeah. So, Skagit Regional Health actually brought me in to help establish a robotic surgery program. Most importantly, for me, is pelvic surgery, which includes prostate cancer surgery. So the old-fashioned way was making a big incision underneath the belly button, go all the way down to the pubic bone and doing what we call an open surgery. More recently, we've been able to do things laparoscopically, which people are pretty aware of laparoscopic surgery, pretty common when removing a gallbladder or an appendix, but what's also done for the removal of prostates. 

More recently, over the course of about the last 20 years, we've developed robotic surgery, which is just a variation on laparoscopic surgery. The robot is not actually doing the surgery. It's just mimicking the movements of the surgeon that's sitting beside the patient in the same operating room. The big benefits of robotic surgery is we can do everything through small little incisions, so typically about a centimeter in size. The robotic surgery we do for prostate cancer is five little incisions across the belly, kind of in line with the belly button. And the big benefits of that is it has been shown to decrease blood loss during surgery, less pain after surgery and increase the time to recovery and kind of getting out of the hospital a little faster.

Evo Terra (Host): So, I think it's obvious, the question here about the benefits, right? I mean, I think you kind of explained a lot of them anyhow, right? So, do you want one big huge incision? Or do you want a lot of little incisions? But are there other benefits that we should be talking about?

Dr. Kyle Schuyler: Well, the benefits that I was mentioning before are mostly benefits to the patient with that faster recovery, less pain, less blood loss. But there's also benefits to the surgeon as well. It's a little bit more ergonomic for the surgeon. So, they tend to have less back issues, back pain down the road. And also, the visibility is a lot better for the surgeon. We're using pretty high-definition cameras that magnify the image and allow us to see things a little bit more closely and perform that surgery a little more easily.

Evo Terra (Host): Do we use robotic surgery all the time for prostate cancer, or are there certain candidates that are even a better candidate for a robot-assisted 

Dr. Kyle Schuyler: So nowadays, it's becoming extremely common that prostate surgery is being done robotically, and actually pretty uncommon that it's being done in the old-fashioned open approach. There are some candidates that are better than others. Things that kind of make robotic surgery more difficult would be people that have had a lot of other prior surgery or if they're not healthy or older in age. Often, we'll sway them to other options for treatment, such as radiation.

Evo Terra (Host): You brought up recovery a moment ago, you said it was quicker. But I'm curious, what does that mean? Obviously, every patient's going to be different. But for someone who undergoes robotic prostate surgery as opposed to the more open style, how does the recovery process differ?

Dr. Kyle Schuyler: It's vastly different. So kind of harping on those benefits we mentioned earlier, most people who have undergone to robotic surgery for prostate cancer, I can usually get them out of the hospital that same day, if not the day after at the very latest. Compared to the open surgery, often people were stuck in the hospital for days to a week, even. So, it really hastens that process of recovery and getting patients home where they're going to do better, get better sleep, tend to get up, moving around a little bit more often. So, that tends to help them recover a little faster.

Evo Terra (Host): Well, thank you very much for that information, Dr. Schuyler. I was most interested at the time when you said that this is becoming the norm. This is what is usually done. And that plus all of the benefits to both the patient and the physician themselves, I think, is a wonderful thing. So, thank you again for the information today.

Dr. Kyle Schuyler: Thanks.

Evo Terra (Host): Once again, that was Dr. Kyle Schuyler, a urologist at Skagit Regional Health. For more information, please visit SkagitRegionalHealth.org to learn more. And if you found this podcast episode helpful, be sure to share it on your social channels and check out our full podcast library for topics of interest to you. I'm Evo Terra. This is Be Well with Skagit Regional Health. Thanks for listening.