NEW YORK, Sept. 27, 2011
Dr. David Samadi, Vice Chairman, Department of Urology, and Chief of Robotics and Minimally Invasive Surgery at The Mount Sinai Medical Center, has performed over 7,000+ robotic prostatectomy procedures in the past ten years for prostate cancer. Robotics is among the latest buzzwords across a wide range of medical specialties. With regard to prostate cancer treatment, the options are vast and the names can often be confusing. For example, robotic prostatectomy surgery has very little in common with robotic radiosurgery, despite the similarities in name.
Robotic radiosurgery, also branded as CyberKnife Robotic Radiosurgery, is not robotic surgery. Developed by Accuray, a radiation oncology company, FDA-approved CyberKnife involves no cutting at all, but rather is radiation for the treatment of cancer. Through a series of 1-5 procedures on different days, the patient receives targeted radiation to the cancerous area. This is a minimally invasive procedure believed to limit the radiation exposure to the surrounding non-cancerous tissue through its precise ability to hone in on the cancerous prostate. A recent multi-center study of low-risk prostate cancer patients showed a 93 percent non-recurrence rate after 5 years, though the procedure is relatively new and data is limited.
In Dr. Samadi’s opinion, this type of radiosurgery has two significant limitations. First, it relies on pre-surgery CT scan data to determine the size, shape and location of the tumor. “We just don’t learn enough from those pre-surgery scans,” stressed Dr. Samadi. “What we think is low-risk, very localized prostate cancer could be more invasive, and could therefore be missed by this type of treatment.” Further, Dr. Samadi clarifies, this is radiation and though the hope is that the cancer will never return, treatment options may be limited if it does. “It’s considerably more challenging to perform robotic prostatectomy surgery after radiation, so if the cancer comes back treatment options can be more limited.”
During a robotic radical prostatectomy procedure, the surgeon uses finely controlled robotic tools consisting of high-resolution cameras and micro-surgical instruments to remove the cancerous prostate. Though minimally invasive, the surgeon is still able to clearly see the entire surgical field. Blood loss is minimal, vision is 3D and is enhanced 10x and the dexterity of the instruments allows an experienced surgeon to guide it in all directions with full rotation. For Dr. Samadi, robotics is the perfect blend of old and new. “I see robotic surgery as a great marriage of the benefits of traditional, open surgery and state-of-the-art technology,” said Dr. Samadi whose patients have a 97 percent cure rate. “Essentially, I can see and do everything I used to see with traditional surgery without risking the same traumas to the patient.”
And seeing is everything, according to Dr. Samadi. “The reality is that cancer staging tests provide limited information. Often, it’s not until I’m in the midst of surgery that I can fully see the extent of the cancer. And there’s a high incidence of post-surgical tests that stage a patient’s cancer at a more advanced level than pre-surgery biopsies were able to.” For this reason, Dr. Samadi believes prostate cancer staging is useful but should not be depended on too heavily.
Last, the peace of mind that follows robotic radical prostatectomy is a major advantage, according to Dr. Samadi. “After robotic prostate surgery, a man’s PSA level typically remainsat zero, and for someone recovering from a prostate cancer diagnosis, that zero is like a golden egg. After radiation, PSA levels can continue to fluctuate, which can be mentally and physically taxing with ongoing prostate cancer tests and treatments.”
More can be seen from prostate cancer expert, Dr. David Samadi, who is also part of the Fox News Medical A-Team.Press Release