Video: Da Vinci Prostatectomy

The following video provides an overview of the radical prostatectomy with the daVinci System from www.intuitivesurgical.com. Dr. J.H. Witt www.pznw.de St. Antonius Hospital Gronau, Germany.

Mayo Clinic Study Shows Advanced Prostate Cancer Previously Considered Inoperable May Be Operable, Curable

ScienceDaily (Apr. 12, 2005) — ROCHESTER, Minn. -- New findings from Mayo Clinic indicate that cT3 prostate cancer, a disease in which the cancer has spread locally from inside the prostate to immediately outside it, is operable and has 15-year cancer survival rates of almost 80 percent.

"These patients have a better chance if they undergo surgery and are living longer than if they undergo radiation therapy," says Horst Zincke, M.D., Ph.D., Mayo Clinic urologist and senior study investigator.

Treatment of this type of prostate cancer has been controversial, as it is a stage 3 cancer in which the malignancy has spread. Due to its advanced stage, some physicians have considered it inoperable via radical prostatectomy, according to Dr. Zincke. He explains that many patients come to him for a second opinion after being told their cT3 prostate cancers could not be surgically removed.

"It's considered inoperable by some urologists and referred to radiation oncology," says Dr. Zincke. "They think surgery can't be done because the cancer is outside the prostate. Currently, only 15 percent are referred for surgery."

The problem with radiation therapy as the first line of treatment for cT3 prostate cancer, according to the Mayo Clinic researchers, is the cancer survival rate, which is 79 percent at only five years. In contrast, with radical prostatectomy, 79 percent of the patients lived at least 15 years. Says Dr. Zincke, "So, obviously surgery does a better job for these patients."

Dr. Zincke also explains that when malignant prostate tumors are high grade -- more aggressive -- they are not especially responsive to radiation therapy alone.
He believes the current trend away from surgery is a disservice to patients. "Patients are being denied surgical treatment when indeed they could have had surgery," Dr. Zincke says.

The cancer survival rates for cT3 prostate cancer with radical prostatectomy not only approach those of cT2 prostate cancer (cancer confined to the prostate), which is 90 percent at 15 years, but they are even more impressive due to the ages of the patients, says Dr. Zincke. "It's significant because the average patient is only 62 years old," he says. "So, a 15-year survival is a long time."

In addition to a favorable survival rate for the cT3 prostate cancer patients studied, the Mayo Clinic researchers also found urinary incontinence rates and complications were akin to those for cT2 prostate cancer.

Some of the patients studied with cT3 prostate cancer had additional, or adjuvant, therapy after surgery, such as hormone therapy or radiotherapy. Dr. Zincke indicates that adjuvant therapy is necessary for patients whose prostate cancer affects the lymph nodes. Surgery alone may be sufficient treatment for those without lymph node involvement. Approximately 50 percent of the cases of cT3 prostate cancer do not involve the lymph nodes.

The study also found that 25 percent of the patients were overstaged -- told that they had a cT3 prostate cancer, a more advanced form, rather than what they really had a cT2 prostate cancer in which the malignancy is confined inside the prostate.

Dr. Zincke points to following patients over 15 years post-treatment as a strength of the study.

"The highest incidence of prostate cancer death is not reached until 11 years after treatment, so 15-year data is significant," he says. "In contrast, five-year data is less meaningful."

Dr. Zincke recommends that patients with cT3 prostate cancer seek a surgeon who performs at least one prostate surgery per week and has completed at least 300 prostate surgeries. He explains that currently only 3 to 4 percent of urologists are doing more than one prostate cancer surgery per week. As they seek an appropriate surgeon, he encourages patients that "if someone tells you your cT3 prostate cancer is inoperable, don't give up."

With more common use of prostate-specific antigen (PSA) testing in the United States, more prostate cancers are now caught earlier, before the cancer spreads. Thus, the frequency of cT3 prostate cancers seen at Mayo Clinic has declined to 3 percent of all prostate cancers. Canada and Europe have much higher rates of cT3 prostate cancer, as PSA testing is not conducted as frequently and more cancers are discovered later than in the United States, allowing the cancers more opportunity to spread outside the prostate.

This study was conducted as a single-institution, retrospective study of 5,652 men who had radical prostatectomy at Mayo Clinic for confirmed prostate cancer.

The title of the paper is "Radical Prostatectomy for Clinically Advanced (cT3) Prostate Cancer Since the Advent of Prostate-Specific Antigen Testing: 15-Year Outcome." The first author is a former Mayo Clinic urology fellow, John F. Ward, M.D., Division of Urology, Naval Medical Center, Portsmouth, Va. Other Mayo Clinic authors include Jeffrey Slezak, Eric Bergstralh, and Michael Blute, M.D.

Robotic Surgery

Further Research

I thought since I have already jumped ahead a few months by beginning to explore the various methods of 'radiotherapy'; that I may as well 'jump' to the next step, following that: i.e. 'Removal of the Prostate'. My surgeon intends to use the 'laporascopic method', rather than the more common 'open surgery' method. Whilst exploring these various options, I came across a radical, new technique now being used in Australia (and elsewhere).


The da Vinci PROSTATECTOMY Method

Da Vinci Robotic prostatectomy is the newest and most advanced surgical option for patients. This method gives a surgeon greater visualization, enhanced dexterity, precision, control and superior ergonomics. This very precise surgery only requires 5 small incisions (1cm) in the abdomen.


About the da Vinci Robotic System

The da Vinci Surgical System is powered by state-of-the-art robotic technology. The System allows your surgeon's hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the operative site. The magnified, three-dimensional view the surgeon experiences enables him to perform precise surgery in complex procedures through small surgical incisions.

The da Vinci System enhances surgical capabilities by enabling the performance of complex surgeries through tiny surgical openings. The System cannot be programmed nor can it make decisions on its own. The da Vinci System requires that every surgical maneuver be performed with direct input from your surgeon. The da Vinci Surgical System has been successfully used in thousands of prostate cancer procedures world-wide.





For patients, there are numerous potential benefits including:

• Shorter hospital stay


• Less pain and less pain medication


• Less risk of infection


• Less blood loss


• Less scarring


• Faster and more complete recovery


• Quicker return to normal activities

Surgical Benefits:

• 3-D visualization provides the surgeon with a true 3-dimensional view of the operating field. This direct and natural hand-eye instrument alignment is similar to open surgery with all-around vision and the ability to zoom-in and zoom-out.


• Dexterity: the da Vinci Robotic System provides the surgeon with intuitive operative controls that allows the experienced surgeon to use his open surgery skills rather than having to use counter-intuitive motions typically required by a laparoscopic approach.


• Surgical Precision: permits the surgeon to manipulate instruments with such accuracy that the current definition of surgical precision is exceeded.


• Range of Motion: the robotic instruments offer the surgeon full range of motion and ability to rotate the instruments through tiny incisions.


• Ergonomics: the surgeon can sit in a comfortable position, allowing him to concentrate fully on the surgery.


• Improved Access: Surgeons perform complex surgical maneuvers through 1-cm ports, eliminating the need for large traumatic incisions.

Source: St Vincent's Clinic

Keyhole Surgery?

I have been thinking lately about the procedure that (hopefully) awaits me sometime in the new year - i.e. 'Keyhole Surgery'!

I say hopefully because the early results (PSA, Gleason Score, Biopsy and CT Scan) seemed to rule out this option. Let me explain.

All of the tests mentioned above, indicated that the cancer had spread beyond the 'capsule' of the prostate. This meant that 'cure' by removal of the tumour was not an option. The best case scenario, meant that I would undergo 'hormone therapy' and could look forward to 3-5 years of life!

Well ... something amazing occured from the time of the Bone Scan which followed only days after the CT Scan. No evidence of the cancer spreading beyond the capsule was found! This meant that a 'cure' became a possibility.

A subsequent blood test showed a 71% reduction in my PSA level even though the treatment was only a few weeks old!

If all goes well and according to plan; the hormone therapy will continue to reduce the size of the tumour and force it into remission. At some subsequent stage, a course of radiotherapy will be introduced to 'kill' the cancer and make surgery a viable option for a cure!

Given that my Urologist prefers to utilise a 'laproscopic surgical procedure' I reasoned that I should conduct some research on this technique. What follows is a video depicting the procedure itself and the benefits it entails. Prostate Cancer - Video