This seems like an easy question. After performing robotic prostatectomies for almost two years, I have learned that proper patient selection is important when performing this operation. Once a man is diagnosed with localized prostate cancer they should have a lengthy discussion with their urologist about the options for cure. They should also consider a second opinion from a radiation specialist or another urologist. One option may be ideal for one man but not ideal for another. Some patients have a philosophy of "doctor, cut out the cancer" and some feel that they would do anything to avoid surgery. A patient needs to be comfortable with their physician and the physician needs to be comfortable with the patient.
There is no ideal patient for robotic surgery, but important criteria should be met. First, the patient's age is crucial. Usually someone 70 years or less is considered a candidate for surgery. Urologists have used this age because if a person has a life expectancy of 10-15 years then they should be considered for surgery. However, some people age better than others. For example, a 62 year old man that plays tennis 3 times per week and does not have any past medical history is clearly in better condition than a 62 year old man with diabetes, high blood pressure and emphysema. The later man is not an ideal candidate for surgery; he should consider another option like external beam radiation.
This brings us to the second criteria: past medical history. This includes medical and surgical history. A person with previous abdominal surgery may not be a candidate for robotic surgery. To perform a traditional robotic prostatectomy, the urologist makes small incisions into the abdominal cavity. If a man had previous colon surgery, for example, there might be extensive internal scarring, called adhesions that would make the prostate surgery very difficult. This person may want to consider having, I dare not say the "old-fashioned" retropubic prostatectomy, perineal prostatectomy or radiation therapy.
Certain medical conditions could make a person "unsafe" to have surgery. This includes stroke, coronary artery disease, heart failure, lung diseases and bleeding disorders. Obesity, which is included in a patient's medical history, can prevent a man from having robotic surgery. Ideally, it is easier to perform surgery on thin men. In addition, obese men do not recover as quickly since their mobility and breathing may be limited. All patients undergoing robotic surgery should be medically cleared by their internist, cardiologist or pulmonologist.
A third criteria that I feel is very important is the patient's emotional well-being. Having surgery that requires a hospital stay, the use of a catheter, and risks urinary leakage and erectile problems is hard to emotionally handle. Some men are fighters and are prepared to do whatever it takes to get through surgery to cure their cancer. Some men are not fighters and require, what I call some "hand holding." These men may not be able to emotionally handle having surgery. This emotional well-being can be difficult to comprehend and it requires a urologist with patience and a good bed-side manner to understand. The patient has to understand what he's about to go through and feel comfortable about the decision he made to treat his prostate cancer.