MONTEGO BAY, St James — Eleven years after performing the first laparoscopic radical prostatectomy at the Cornwall Regional Hospital (CRH), based here, local urologist Dr Roy McGregor is still "passionate" about performing the life-changing procedure.
Laparoscopic radical prostatectomy is a surgery used to treat the early stage of prostate cancer. According to Dr McGregor, this procedure promises men the opportunity to continue engaging in sexual activities after recovery. But, Dr McGregor told the Jamaica Observer that a laparoscopic radical prostatectomy is only an option once the cancer is detected early through regular prostate screenings.
"The whole idea is to catch it [prostate cancer] before it spreads and you can then cure it with…something that I am very passionate about, the keyhole surgery or laparoscopic surgery for prostate cancer," Dr McGregor, the head of urology for CRH, explained.
The urologist noted that laparoscopic radical prostatectomy is a "less traumatic procedure" as opposed to the traditional open radical prostatectomy and radiation treatment. Patients also get very little scarring from this surgery as small incisions are made on the stomach, Dr McGregor told the Sunday Observer.
"We can do the whole surgery down a little portal with a telescope. We put the instrument down a little portal in the abdomen and do the whole surgery while looking at a television screen. We then disconnect the prostate, put it in a bag, and pull it out through a small incision," the urologist said.
He continued, "The blood loss is minimum…if we do it the other way the blood loss is about a litre, but if you do it microscopically, it is about 150 millilitres, so it is a huge difference. Also, there is less pain and the patients are up walking around the next day. About 20 per cent of patients go home the next day and the other 80 per cent average two nights in the hospital. The whole process of surgery now is less traumatic and if you catch it early you can spare the nerves so the patients can get erections."
"If you spare the nerves on both sides, more than 80 per cent of patients who had good erections previously will continue to have them after surgery," Dr McGregor added.
Ultimately, Dr McGregor stated the laparoscopic approach promises those diagnosed with prostate cancer a second chance of leading a normal life.
"I think the bottom line is, with surgery if you spare the nerves, 80 per cent can get an erection and over 90 per cent do not experience any form of urine leakage. After you do your surgery there is a good chance of going back to normal, but that is if you catch it early," he said.
"I think the real take-home message is that prostate cancer is silent when it is early and screening is very important," the urologist added.
As he continues to stress the importance of early detection and screening, the urologist said Jamaican men between the ages of 39 and 71 should visit their doctors annually to check for irregular or enlarged prostates. The urologist recommends that both the prostate-specific antigen (PSA) test and digital rectal examination (DRE) are done to ensure that a full screening is provided.
"Prostate cancer doesn't affect young people, but it starts at about 40. Overseas, they say about age 45, but because Jamaicans have a higher risk of prostate cancer we recommend they start at 40. If you have a relative with prostate cancer then you are at a higher risk of developing cancer," he said.
"Also you are at a higher risk of getting a more aggressive form where the PSA test doesn't work as reliably. The PSA test will be normal in about 10-15 per cent of prostate cancer, so you cannot just use the PSA to screen and say you won't do a rectal examination because you will miss several cancers."
Dr McGregor told the Sunday Observer that with men over 40 susceptible to the deadly disease, he will continue encouraging healthy practices and habits among this population.
"The main risk factor for prostate cancer is genetics, so a family history, and I think we have a disproportionately higher number of genetic cases. There is also the combination of our environment [and] what we eat. Certain things are correlated with prostate cancer, we may not be able to say that they cause it for sure, but we recommend that you avoid dairy, and red meat while increasing your fruits and nuts," he said.
While he makes provisions for prostate cancer patients seeking other treatment options, the urologist believes that this procedure is the better choice.
"For people who don't like surgery, you can do radiation. What I normally advise patients, especially if they have an aggressive form of cancer and are young, is to choose the best treatment model that allows multi-modal treatment, so if surgery doesn't work then you have a crack at radiation," Dr McGregor stated.