M. D. Anderson Cancer Center
Date: September 2008
Duration: 0 / 04:06
Every year is approximately 180,000 new cases of prostate cancer diagnosed in the United States. The recommendations are to start screening when you're fifty. If you're African-American or have a family history, there’s a couple of different guidelines, but it’s low forties - forty to forty five would be the age to start and then just do it annually with your primary physician, is the most common way to get that down.
Prostate cancer screening using the blood test PSA has been around since the late 1980's and it's changed to a number of things. When you didn't have that test, men actually commonly came to the office having symptoms of prostate cancer. Now they come in feeling fine and you're just looking at a blood test. And as we keep finding these cancers and treating them, what we're finding is that they're being diagnosed at earlier and earlier stages. Actually the result of that is that some men with prostate cancer actually can just be monitored because we don't think that they're going to be harmed from prostate cancer. Other men though if there's a number of positive biopsies and depending on the grading from the pathology report, we would say go ahead and treat this. One nice thing about prostate cancer, so to speak, is that it has a very slow biological clock and so men can actually take their time and get opinions and evaluations and really consider all these treatment options carefully. No one has to rush into a treatment option immediately.
The major side effects can be sexual function issues, bladder function, as well as bowel function. And depending on which treatment you do, they all have side effects. They're just, sort of distributed differently in terms of severity and time. The good news is they all heal fairly well within the first three or six months, and studies have shown that general, physical, social function and the other sort of general measures of quality life were pretty minimally impacted from these treatments.
The initial way to do a minimally invasive surgery is with hand-held instruments to do the operation. Now we're using robot assisted driven instruments. But one priority is cancer control and for most folks followed by urinary control and sexual function. One nice thing about minimally invasive surgery is that some of the bleeding is decreased, and that takes some of the pressure off the surgeon to control that, and to just sort of focus on the finer points of the operation.
The current robot called "da Vinci" that we use, truly does accomplish what you want to accomplish. It's not a thinking robot, it's a robot that basically interfaces with my hands, and with my eyes and mimics my exact motions. And believe it or not, it gives you a little bit of tactile feedback. If you grab a needle you can actually feel in your fingers a little bit resistant enough to pinch that needle and feel it, and you can feel it passing through a tissue. That, plus the incredible vision, your brain just learns to work, sort of as a harmony and if you will with this machine and accomplish what you wanted to accomplish in the surgery. When you can focus your eyes on the nerve bundles and you have this delicate instruments to tease off the right planes, then that helps with preserving sexual function and the urinary function is really all about getting the edge of the prostate removed and sparing those important muscles that wrap around the urethra and the robot allows you to see that very well.
We have decades of experience of open surgery, so our program has been designed to merge everything we've learned about open surgery and doing minimally invasive surgery. Some of that has come through recruitment, some of us have spent such as myself time in Europe and other places learning minimally invasive surgery techniques and then bring the back to M. D. Anderson what we learned and been practicing all along. As a surgeon we just want the perfect operation for every patient with excellent outcomes.
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