WITNESS: A prostate cancer patient trusts in a robot

Douglas Hamilton has been a correspondent for Reuters for many years and is currently the Bureau Chief for the Balkans, based in Belgrade. In this story, he relates how a diagnosis of cancer led him to the United States for robotic surgery, a new procedure using advanced technology to save lives with less pain, fewer complications, and a better chance of a full return to normal.

By Douglas Hamilton

NEW YORK (Reuters) - Scary as it sounds, robotic surgery is taking a lot of the dread out of prostate cancer.

My experience of the 21st century treatment began at New York Presbyterian Hospital a few days into 2008, with an introduction by surgically masked Chip Berryhill.

"There's the robot, and over there is the console where Dr. Tewari will operate," he instructed casually, as I climbed onto a precariously narrow operating bench halfway between them.

Faintly menacing, the four-armed da Vinci machine stood against the wall, waiting to be moved into position once I had lost consciousness under the anesthetic.

Berryhill is physician assistant to Dr. Ash Tewari, who is recognized as one of the world's top practitioners of a procedure changing the face of modern medicine.

Prostate cancer is the second leading cancer killer for men, after lung cancer. A simple blood test now helps detect it, before it spreads. But eradication of the threat through surgery carries risks men dread -- incontinence and impotence.

"It's a tough call," admitted Prof. Wolfgang Aulitzky of Vienna's Confraternitaet clinic, after diagnosing my cancer in October. There were no symptoms, just a high score on the PSA (prostate specific antigen) blood test.

The test is not perfect. It may indicate cancer where there is none, or miss it where it exists. Men with high PSA and nerves of steel may chose to ignore it. Others have a biopsy.

Little cores are cut from the walnut-sized gland. Even if the biopsy does detect some evidence of cancer the procedure can miss aggressive tumors that kill quickly.

There are a range of treatments for the cancer. But given my biopsy results the doctors said the only real choice was decisive action.

"Radiotherapy to slow the cancer is an option for older men," said Aulitzky when he reviewed my biopsy results. "In a healthy man of 60 we go for longevity and that means radical prostatectomy to remove it."

COMPETING AIMS

I embarked on a frenzy of reading, then accepted the need to choose: risk surgery or risk early death.

For the prostate surgeon, the challenge lies in two fundamentally competing goals: eradicating the cancer while preserving to the maximum the patient's quality of life.