Diabetes, Obesity and Prostate Cancer: Is Surgery Still an Option?
Happy New Year. I would like to start the New Year answering one of ProstateCommons SharePosts. An overweight man with diabetes was diagnosed with "early prostate cancer." He was advised against surgery because of his obesity and diabetes. He is looking for advice for men in a similar situation.
First, let me tell you that this man is not alone. There are plenty of men diagnosed with prostate cancer who have obesity, diabetes, or both. It is important to know the age of this man, but since we do not in this situation we'll hypothetically say he is 60 years old. At 60 years of age, this man could live atleast another 15 to 20 years if his diabetes and obesity are under control. In that case, he is a candidate for surgical intervention to treat his prostate cancer. There are essentially three ways the prostate can be surgically removed for a cancerous growth. The first method is the radical retropubic prostatectomy. In this operation, an incision is made from the belly button to the pubic bone and the prostate is removed. This operation can be difficult if a man has a large belly. In fact, there are research studies showing that obese men have a higher risk of cancer recurrence with this technique. As a practicing urologist, I will tell you that this is very difficult operation. The second method is the radical perineal prostatectomy. In this operation, the prostate is removed through an incision between the scrotum and anus (the perineum). This method has been favored for obese men since they have less fat in this area of the body compared to a large belly. The third method is the robot assisted laparoscopic prostatectomy. This is the newest, cutting edge surgery to remove the prostate gland. Small incisions are made in the abdomen (keyholes) to place ports and visualize the pelvis. Laparoscopic and robot instruments are used to remove the prostate gland. There are many urologists who feel that this operation is very safe for obese men. Essentially, the urologist can see the anatomy better with the laparoscopic cameras to improve cancer control.
In general, it is important to lose weight for a person's overall health and every man should lose weight prior to surgery. It improves high blood pressure and reduces the risk of diabetes. Being overweight is not contraindicated for surgical cure of prostate cancer.
Diabetes is a common disease in America. Unfortunately, it cannot be cured, but it can be controlled. Men with adequate diabetes management can live long healthy lives. However, men with "brittle" uncontrolled diabetes are plagued with advanced heart disease, kidney problems, blindness and vascular disease. These men do not live long healthy lives. If a man has well controlled diabetes and has a normal life span he can be a candidate for surgery. So, let's go back to our 60 year old man with early prostate cancer and diabetes. Certainly, he can be a candidate for surgery using any approach listed above. If this 60 year old man has very bad diabetes with worsening heart disease or kidney problems, then he should consider other treatment methods such as brachytherapy (seed implant), external beam radiation, hormonal therapy or watchful waiting.