A Better Treatment for Prostate Cancer
Westchester Magazine, April, 2003
A Better Treatment for Prostate Cancer?
LAPAROSCOPIC SURGERY IS LESS INVASIVE, LESS PAINFUL AND REQUIRES A SHORTER RECOVERY TIME THAN OPEN SURGERY BUT DOES IT WORK AS WELL?
Jennifer K. Covino
With the laparoscopic procedure, less blood is lost, patients spend less time in the hospital, and they have minimal pain and discomfort.
When 67-year-old Thomas Cahill of Rye learned he had prostate cancer, he knew what he didn't want. A friend with the same diagnosis had undergone open surgery and was left with an "awful-looking' abdominal scar, lingering fatigue and difficulty controlling his bladder.
So Cahill opted for a less invasive procedure called laparoscopic radical prostatectomy, in which a surgeon extracts the prostate with the aid of fine instruments, including a tiny camera, threaded through several dime-sized incisions in the abdomen. The procedure promises less pain and less blood loss, plus a shorter hospital stay and a quicker recovery.
Two weeks after his surgery, Cahill was back on his feet. In fact, the retired carpenter boasts that over the past several months, he's worn out the treads on two pairs of shoes, walking two to three miles a day.
"Everything happened exactly as my doctor said it would," he reports. "He said in a week or so the incisions would just look like mosquito bites, and it was true."
In 2003, more than 220,000 men, 70 percent of them age 65 and older, will be diagnosed with prostate cancer, according to the American Cancer Society. A slow growing disease, prostate cancer is often detected early through a digital rectal exam or a blood test for prostate specific antigens-both are recommended annually for men age 50 and over.
In 2003, more than 220,000 men will be diagnosed with prostate cancer.
The prostate, a walnut-shaped organ located just below the bladder and in front of the rectum, is intersected by the urethra, the tube that carries urine. It is the gland that manufactures seminal fluid that transports sperm. Nerves found next to the prostate are involved in producing erections.
Cancer treatments include radiation therapy, hormone treatment, and if the disease has spread beyond the organ, chemotherapy. Surgery is recommended when cancer is confined to the prostate and the patient is under age 70.
But because of its location in the body, removing the prostate is tricky business. Doing so always results in infertility (although sperm may later be harvested from the testicles), and it may result in incontinence and/or impotence.
"The nerves responsible for sexual function are right near the prostate," explains Dr. Samadi. Says Dr. David B. Samadi, a urologist at The New York United Medical Hospital Center in Port Chester and Cahills physician: "It's delicate work to spare the nerves without leaving any cancer behind:" Even when the nerves are spared, he says, sexual potency may take up to a year to return and trauma to the nerves may prevent a man from achieving erections. And although a man may achieve orgasm post-surgery, it will always be "dry," since the mechanism for producing semen is no
Laparoscopic radical prostatectomy is an exciting development because it appears to perform as well as traditional open surgery, while being less invasive.
Laparoscopic radical prostatectomy is an exciting development because it appears to perform as well as traditional open surgery, while being less invasive. In the United States, open surgery, formally called open radical retropubic prostatectomy, is the most common operation for prostate cancer and it is performed through a single abdominal incision of five- to 10-inches.
With the laparoscopic procedure, less blood is lost, patients spend less time in the hospital, and they have minimal pain and discomfort, usually treatable by Tylenol. Plus urinary continence usually returns more quickly after the laparoscopic procedure. That's because the tiny magnification camera gives the surgeon visual acuity, enabling him to make tighter sutures as he reattaches the urethra to the bladder. The catheter may be removed as early as three days after the surgery, rather than two weeks later.
Results for potency are about the same: anywhere from 50 to 70 percent of patients will experience a return in sexual function within a year, according to Dr. Samadi.
Though promising, the laparoscopic procedure must first undergo long-term studies to determine its effectiveness, even though it's not considered experimental. Laparoscopic radical prostatectomy has only been practiced in this country for about four years. It was developed here in the early '90s but then dismissed as too costly and time-consuming, before finally being picked up by the French, who have since fine-tuned it. Today, the technique has been gaining increasing interest among doctors in the United States, including urologists at Memorial Sloan Kettering Cancer Center in New York City, Henry Ford Hospital in Detroit, MI, The Cleveland Clinic in Cleveland, OH, and Johns Hopkins Medical Institutions in Baltimore, MD.
Dr. Li-Ming Su, assistant professor of urology and director of pelvic laparoscopy and stone disease at Johns Hopkins, says he and his colleagues are "cautiously optimistic" and "encouraged" after performing 90 of these procedures in the past two years.
Dr. Su reports that Johns Hopkins and other major centers in the United States and Europe are currently conducting long-term longitudinal studies to determine blood loss, post-operative pain, length of hospital stay and convalescence with the newer technique. "More importantly," he says, "the urologic community is awaiting longer term follow-up on cancer cure rates, urinary continence and the preservation of sexual function:' Five to 10 years of data may be needed before statistically valid comparisons can be made between the laparoscopic technique and open surgery, he notes.
Dr. Samadi reports results have been excellent in his last 30 cases. Every patient, including Thomas Cahill, recovered quickly after surgery and is cancer-free.
"I think it's great when a patient comes in after surgery, and I can tell him that he's cured," Dr. Samadi says. "It's just you against the cancer, and when you see that you can beat it, that's the ultimate joy"
Jennifer K. Cavino is a New Canaan-based freelance writer who reports frequently on health-related issues.
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