Precise, Minimally Invasive Prostate Cancer Removal
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Transcript of Precise, Minimally Invasive Prostate Cancer Removal
David Lieber MD
Springfield Clinic Urology
Precise, Minimally Invasive Prostate Cancer Removal
What is the Prostate?
• Male sexual gland
• Adds nutrients and fluids for sperm
• This fluid is added to sperm during ejaculation
• Urethra (urine channel) runs through the middle of the prostate
Testes
Prostate
Seminal Vesicles
Rectum
Bladder
Urethra
Photo sourced from: www.daVinciprostatectomy.com
What is Prostate Cancer
• Abnormal cells growing out of control
• Spreads and invades local tissues
• Prostate Cancer…
– Begins with a small tumor in
the gland
– First spreads to the local
lymph nodes
– Then spreads to the bony skeleton and other areas of the body
Photo sourced from: www.daVinciprostatectomy.com
Prostate Cancer: Highly Prevalent
• Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men1
• Prostate cancer is the second most frequently diagnosed cancer in men, and the sixth leading cause of cancer death in men 2
Photo sourced from: www.daVinciprostatectomy.com
Early Detection & Aggressive Treatment = Highly Survivable
• 91% of prostate cancer diagnosed in the US is clinically localized3
• US 5-year survival rate is 99% vs. <80% for many other developed nations4
Staging of Prostate Cancer
• Prostate Specific-Antigen (PSA)• Digital Rectal Exam• Trans Rectal Ultrasound• Gleason Score• Bone Scan• +/- CT scan or MRI• Biopsy and TNM staging system
– Tumor, Nodes, Metastases
Photo sourced from: www.daVinciprostatectomy.com
• Tumor cannot be felt• T1a – cancer found in
≤ 5% TURP specimen• T1b - cancer found in
≥ 5% TURP specimen• T1c – cancer found as
a result of PSA elevation only
Prostate Cancer – T1 Disease
Photo sourced from: www.daVinciprostatectomy.com
• Tumor can be felt during DRE (digital rectal exam)
• T2a – felt on ≤ one half of one side of prostate
• T2b – felt on ≥ one half of both sides of prostate
• T2c – felt on both sides of prostate
Prostate Cancer – T2 Disease
Photo sourced from: www.daVinciprostatectomy.com
• Cancer has spread beyond the prostate
• T3a – extra capsular extension
• T3b – tumor invades seminal vesicle(s)
Prostate Cancer – T3 Disease
Photo sourced from: www.daVinciprostatectomy.com
• Cancer has invaded local organs/tissues
– Bladder muscle
– Pelvic side wall
• May cause pain in joints and back
Prostate Cancer – T4 Disease
Photo sourced from: www.daVinciprostatectomy.com
What do my biopsy results mean?
• Prostate cancer graded on appearance of cancer cells
• Gleason grading system– Gleason grade ranges
from 1 (least aggressive) to 5 (most aggressive)
• Gleason score (2-10)– Most common cell grade
(first) added to second most common cell grade, e.g., Gleason 7 (3+4)
Gleason Grading
Least aggressive
Most aggressive
1
2
3
4
5
Photo sourced from: www.daVinciprostatectomy.com
Prostate Cancer Treatment Options
• When prostate cancer is believed to be localized, there are five common treatment options available to a patient:
– Surgery to remove the cancerous prostate (radical prostatectomy)
– Radiation of the cancerous prostate, through either external radiation or radioactive seed implants (radiation therapy or brachytherapy, respectively)
– Freezing of the cancerous prostate (cryotherapy)
– Hormonal therapy, which is non-curative and often done in conjunction with radiation therapy or cryotherapy
– Observation (watchful waiting)
Effective cancer removal
Quicker recovery and return to normal urinary function
Better chance of preserving delicate nerve structures that responsible for sexual function
Prostate posterior
Neurovascular bundle and nerve branches
da Vinci® Advantage for Prostatectomy
Why da Vinci® for Prostatectomy?Precise, Minimally Invasive Cancer Removal
Enables Meticulous DissectionEndowrist instruments for precise dissection
Provides Superior Visualization3D High Definition View
Allows Precise SuturingIntuitive motion with tremor filtration & motion scaling
Photos sourced from: www.daVinciprostatectomy.com
da Vinci Surgery is minimally invasive
Instruments of the da Vinci Surgical System are small and fit through tiny incisions
Photos sourced from: www.daVinciprostatectomy.com
Surgery: Gold Standard Treatment for Localized Prostate Cancer
“Because the entire prostate gland is removed with radical prostatectomy, the major potential benefit of this procedure is a cancer cure in patients in whom the prostate cancer is truly localized."
--(2007 AUA clinical guidelines3)
Surgery: Confidence to Know Status
• Up to 35% of tumors can actually be more aggressive than the pre-surgery assessment and biopsy results indicated5
• Choosing surgery can: – Enable easier detection of cancer
recurrence through PSA monitoring after a radical prostatectomy than after radiation therapy6
– Preserve your treatment options if there is a recurrence7
Long-Term Survival and Localized Prostate Cancer
A study of 3,159 patients found that 15 years after treatment, those who had undergone radical prostatectomy had a 40% lower risk of death from prostate cancer than radiation patients.8
Photo sourced from: www.daVinciprostatectomy.com
Surgery: Longer Survival vs. Any Other Treatment
9) Merglen A, et al. Short- and long-term mortality with localized prostate cancer. Arch Intern Med 2007; 167:1944-1950.Photo sourced from: www.daVinciprostatectomy.com
Long-Term Survivability Matters
• Why should we be focused on just 10-year survival for older patients?
• Average 65 year old can expect to live for 18.4 years (CDC 2007 estimates)
Clinical Concerns for Prostatectomy
1.Cancer Control – Margins
2.Urinary Control – Continence
3.Sexual Function – Potency
“The Big 3”
Precision Matters: Cancer Control
10
11
12
13
Effective Cancer Control Shown with da Vinci Surgery (T2 positive margins)
Photo sourced from: www.daVinciprostatectomy.com
Precision Matters: Urinary Control
1414
15
15
16
16
Faster Return to Continence with da Vinci
Precision Matters: Urinary Symptoms
17
17
17
17
Increased Pain with Radiation
Photo sourced from: www.daVinciprostatectomy.com
Precision Matters: Cancer Control
Several studies have shown that patients potent prior to surgery have experienced a high level of recovery of sexual function (defined as an erection sufficient for intercourse) within a year following da Vinci Surgery.
1819
2021
High Level of Sexual Function at 1 Year with da Vinci
Photo sourced from: www.daVinciprostatectomy.com
da Vinci: Get Back to Your Life
• As a minimally invasive treatment, da Vinci Surgery for prostate cancer offers numerous potential benefits compared to traditional open surgery.
• Potential benefits include:– Shorter hospital stay22
– Significantly less pain23
– Less blood loss and fewer transfusions24
– Less scarring– Faster return to normal activities25
Growth of robotic-assisted prostatectomy
da Vinci® Prostatectomy is the Number #1 treatment for Prostate Cancer in the
U.S.
Photo sourced from: www.daVinciprostatectomy.com
Appendix
Surgery vs. Surgery
Outcome da Vinci Surgery Open Surgery Laparoscopic Surgery
Cancer control
T2 margin status 2.51 5.92 7.73
Complications
Length of hospital stay 1.2 days4 3 days5 2.5 days13
Major 1.7%4 6.7%5 3.7%6
Minor 3.7%4 12.6%5 14.6%6
Urinary function
3 month 92.9%7 54%8 62%9
6 month 94.9%7 80%8 77%9
12 month 97.4%7 93%8 83%9
Sexual Function
12 month 86%10 71%11 76%12
da Vinci Surgery vs. Traditional Surgical Approaches to Prostate Cancer
da Vinci Surgery is the #1 Treatment Choice for Prostate Cancer.
More men in the United States choose da Vinci Surgery than any other treatment option.14
28)
References: Surgery vs. Surgery
1) Patel VR, Thaly R, Shah K.Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May;99(5):1109-12
2) Scardino PT. Open Radical Retropubic Prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, California, Sept. 30 – Oct. 1 2005
3) Touijer K, Kuroiwa K, Saranchuk JW, Hassen WA, Trabulsi EJ, Reuter VE, Guillonneau B. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgicalmargin. J Urol. 2005 Mar;173(3):765-8. p. 766 (Results)
4) Bhandari, A., McIntire, L., Kaul, S.A., Hemal, A.K., Peabody, J.O., and Menon, M. (2005). Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 174, 915-918.
5) Brown, J.A., Garlitz, C., Gomella, L.G., McGinnis, D.E., Diamond, S.M., and Strup, S.E. (2004). Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urologic oncology 22,102-106.
6) Guillonneau, B., Rozet, F., Cathelineau, X., Lay, F., Barret, E., Doublet, J.D., Baumert, H., and Vallancien, G. (2002). Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. The Journal ofurology 167, 51-56.
7) Locke, DR, Klimberg IW and Sessions RP. Robotic Radical Prostatectomy With Continence And Potency Sparing Technique: An Analysis Of The First 250 Cases. Submitted To Journal Of Urology, Publication Date TBD. p. 5 table 4.
8) Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul;164(1):242. p. 59 table 1.
9) Goeman, L., Salomon, L., La De Taille, A., Vordos, D., Hoznek, A., Yiou, R., and Abbou, C.C. (2006). Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol 24, 281-288.
10)Kaul, S., Bhandari, A., Hemal, A., Savera, A., Shrivastava, A., and Menon, M. (2005). Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology 66, 1261-1265.
11)Parsons JK, Marschke P, Maples P, Walsh PC. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology. 2004 Nov;64(5):987-90.
12)Su, L.M., Link, R.E., Bhayani, S.B., Sullivan, W., and Pavlovich, C.P. (2004). Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology 64, 123.
13)Dahl DM, L’esperance JO, Trainer AF, Jiang Z, Gallagher K, Litwin DE, Blute RD Jr. “Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center.” Urology. 2002 Nov;60(5):859-63.
14)Claim based upon U.S. data on file.