Precision Surgery in Urological Cancer
Introduction: With recent technological advances and in the age of rapid access with internet, it is appropropriate to embark on precision medicine. Indeed “precision medicine in urology” was the theme of the 26thMalaysian Urological Conference held in Kuching on 23-26 November 2017, with almost a thousand delegates. Urological surgery has been traditionally precision medicine eg endoscopic ureteroscopic laser stone fragmentation, ESWL or extracorporeal shockwave lithotripsy, PCNL or percutaneous nephrolithotripsy.
Methods: A better understanding of tumour biology allows doctors to target the different pathways of tumour growth. Previously untreatable tumours can now be controlled or downsized to allow surgical excision. Unfortunately such targeted therapy is usually from developed countries, with a typical price tag of RM10,000 per month. Good history taking and clinical examination (including rectal exam in urology) remains the basis of a good doctor patient relationship. With modern imaging techniques, the tumour can be excised accurately. New technology, including fusion software allows surgery to be done by keyhole surgery and assisted by robotics eg the daVinci robot available at Sarawak GH. Clinical cases will be presented.
Conclusion: The established doctor patient relationship, nutrition, exercise & spirituality remains the hallmark of medicine. However, precision medicine is another pathway forward in urological therapy. Further advancements will allow genetic counselling, prevention, targeted therapy and treatment of any significant earlier disease.
@ Academy for Silent Mentor, Kuching, Cancer Forum, 15 December 2018
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