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For years, the main goal of prostate cancer surgery was to get rid of the cancer, potentially adding years of life. But advances in prostate cancer screening and treatment have led to radical shifts in treatment recommendations, centered on a key question: How can we not only extend life but also improve a man’s quality of life after prostate cancer surgery?
Prostatectomy—surgery to remove the prostate due to cancer—has evolved over my 15 years of performing these procedures at MedStar Health.
As the Mid-Atlantic’s most experienced nerve-sparing robotic prostatectomy provider, I’ve seen techniques shift from open surgery with long-term urinary, sexual, and mental health side effects to a modern, precise, minimally invasive procedure that greatly reduces negative side effects with dramatic improvements to patients’ long-term quality of life.
For men in the U.S., prostate cancer is the second most common cancer and second leading cause of cancer death. By the end of the year, nearly 250,000 men are expected to receive a new diagnosis and just over 34,000 men will die from prostate cancer.
The good news is that diagnosis of new prostate cancer cases continues to decline while survival rates increase. Reduction of stigma around men’s mental health—paired with advanced screening and imaging technology and refinements in robotic surgery—are making all the difference in not only successful cancer treatment outcomes but also men’s happiness and satisfaction with their care.
Focusing on men’s mental (and physical) health.
Having prostate cancer and undergoing treatment historically has been associated with negative side effects men might be hesitant to discuss, including:
Because better screening technology helps us detect cancer sooner, patients are living longer—and our modern treatment options support both longevity and quality of life.
At MedStar Health, we look at the whole picture to determine the most effective treatment options that give patients the best chance to maintain or regain their sense of well-being. Our multidisciplinary team includes not only cancer experts and surgeons but also licensed therapists to help manage mental health symptoms. We make every effort to provide a safe, honest environment where patients feel comfortable discussing their concerns.
Quality of life will be a leading area of focus in our fall 2021 study with our research partner, Georgetown Lombardi Comprehensive Cancer Center, in collaboration with Hackensack Medical Center in New Jersey. The study will research treatment options that lessen the long-term effects of prostate cancer, as well as bladder and kidney cancer, to help patients live longer, healthier lives.
MRI technology revolutionizes screening results.
Advances in magnetic resonance imaging (MRI) technology over the past five years have revolutionized the way we screen men for elevated levels of prostate-specific antigen (PSA)—a protein made in the prostate and released into the bloodstream.
Men with prostate cancer typically have elevated levels of PSA. Previously, when high levels were detected through a PSA blood test, we would conduct a biopsy to collect and test prostate gland tissue for cancerous cells. This process had several drawbacks:
- PSA tests can show elevated levels when no cancer is present.
- Elevated PSA can be a sign of other conditions, such as benign prostate enlargement, a urinary tract infection, or an inflamed prostate gland.
- Not all prostate cancers are life-threatening, since the cancer is slow growing in many men. Thus, the current goal is to identify patients at high risk of having clinically significant prostate cancer while avoiding unnecessary biopsies in men at low risk.
Using advanced MRI technology, we’ve reduced the number of biopsies we perform by almost half while detecting the same number of cancer cases. Getting sharper, clearer MRIs also helps clinicians and patients make better decisions about who should undergo biopsy for prostate cancer—and who might benefit from certain treatments, including nerve-sparing robotic prostatectomy.
The benefits of robotic surgery.
MRI technology helps us precisely visualize where the cancer is located and whether it is spreading. Based on this information, as well as a patient’s age, overall health, and personal preferences, prostate cancer treatment can include:
Surgery is typically the best way to remove the cancer, and MedStar Health continues to lead the Mid-Atlantic region in robotic surgery expertise. Using the da Vinci® surgical robot system, I have performed over 3,000 robotic nerve-sparing radical prostatectomies to treat prostate cancer by removing the entire prostate.
Robotic surgery uses small incisions in the abdomen, through which the surgeon inserts tiny instruments. The robot’s movements mimic the human wrist but with greater dexterity, and its small camera provides a 3-D, magnified view of the prostate and surrounding tissue. Using a console to guide these instruments with extreme precision, we remove the prostate with minimal disruption to the surrounding healthy nerves and tissue that support normal urination and erection.
Benefits of this approach compared to open surgery include:
- Shorter recovery time
- A faster return to your normal urinary and sexual function
- Lower risk of surgical site infection
- Less blood loss
- Less pain overall
Robotic surgical removal of the prostate is most beneficial for younger men because radiation can still be used if they have a cancer recurrence after surgery. Regardless of the patient’s age, I approach every patient’s treatment as if it were my own or a family member’s. I am frank and transparent about the risks and complications, such as urinary or erection problems, and remind them that healing is not the same in all men.
MedStar Health has 15 years of follow-up data on men who have had the procedure. Many of my former patients are willing to share their experience with men who are considering the surgery. Every patient who is strongly considering surgery will have the option to speak with a former patient of a similar age and circumstance, which gives them more relatable expectations for life before and after surgery.
As my practice is solely dedicated to performing robotic nerve-sparing prostatectomies, I have assembled a robotic surgery team around me which allows me to be directly available to all of my patients and their families through my email and our myMedStar Patient Portal; this communication approach has been especially helpful for men who travel more than one hour away from DC for their surgeries. I am here to support my patients and their families all the way from consultation through surgery and recovery.
What to expect during recovery.
After surgery, patients stay in the hospital for 23 hours or less—a major reduction from the three- to five-day stay typically required for open surgery. Most patients can walk independently the day of surgery, and most feel well enough to go back to work after three weeks.
You will need to keep a catheter in for seven days (instead of three weeks with open surgery), and patients can safely remove the catheter at home. After it’s out, you can start driving right away—but you don’t have to drive to follow-up appointments! If you have no post-operative issues, we can conduct our follow-up visits virtually to save you time and stress.
New technologies and research.
Beyond the da Vinci robotic surgery system, many more technologies in the pipeline will continue to allow surgeons to deliver increasingly precise prostate cancer care.
Experimental studies and trials are using energy-based technology, such as cryotherapy, laser therapy, and high intensity focused ultrasound (HIFU), to develop effective treatments that focus only on the affected tissue. Whether robotically or manually driven, energy-based therapies are the new frontier in prostate cancer treatment.
To determine if prostate cancer screening is right for you, first consider the risk factors: age over 50; being of African descent; having a family history of prostate cancer or an inherited gene mutation linked to colon, breast, or ovarian cancer.
Falling into one or more of these categories doesn’t mean you should be screened immediately, however. Current prostate cancer screening guidelines from the U.S. Preventive Services Task Force recommend that:
- Men age 70 or older should not be routinely screened for prostate cancer.
- Men age 55 - 69 should discuss the risks and benefits of screening with their doctor and decide together when to begin screening.
When you and your doctor decide to proceed with screening, your well-being will continue to be our highest priority.