Precise, Minimally Invasive Prostate Cancer Removal
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Precise, Minimally Invasive Prostate Cancer Removal

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Did you know all men are at risk of developing prostate cancer? The fear of having prostate cancer can be devastating to men. A diagnosis of cancer has a profound impact on one's life, particularly ...

Did you know all men are at risk of developing prostate cancer? The fear of having prostate cancer can be devastating to men. A diagnosis of cancer has a profound impact on one's life, particularly in the case of prostate cancer. However, it is most successfully treated when found early. Please join Dr. David Lieber for a FREE informational event to learn more about the symptoms & warning signs, diagnosis and treatment for living with Prostate Cancer. 

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  • 1 http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.70619/k.446E/Risk_Factors.htm. 2 http://www.cancer.org/downloads/STT/Global_Cancer_Facts_and_Figures_2007_rev.pdf
  • 3 Prostate cancer clinical guideline update panel. Guideline for the management of clinically localized prostate cancer: 2007 update. Linthicum (MD): American Urological Association Education and Research, Inc. 2007; 82. 4 http://www.cancer.org/downloads/STT/Global_Cancer_Facts_and_Figures_2007_rev.pdf
  • Slide 6 Objective Review the key value propositions for da Vinci Prostatectomy. Script I want to show you a series of video clips that will help you see the surgical advantages of da Vinci and why it enables precise, minimally invasive cancer removal. – CLICK - The first clip clearly shows the surgeon visualizing and dissecting the prostatic fascia laterally. This enhanced visualization allows surgeons to preserve the neurovascular bundle which is key in retention of sexual function. -CLICK-Next, we transition to the surgeon demonstrating the ability to meticulously dissect the prostate posteriorly. da Vinci enables superior tissue plane identification - in this case, Denonvilliers fascia - and surgical precision during this difficult dissection near the rectum. -CLICK- Finally, the third clip highlights the precision da Vinci enables during a procedural step in a radical prostatectomy – the anastomosis. The dexterity of the EndoWrist instrumentation allows the surgeon to suture with greater precision and confidence, resulting in a more complete anastomosis which can translate into faster return of urinary continence. Closing Statement/Transition “ These video clips show how the vision, precision and control of the da Vinci system enable better surgical technique. Let’s look now at how this surgical advantage improves clinical outcomes.
  • 5 King CR, Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J. Cancer (Radiat. Oncol. Invest.) 2000; 90,305-311. 6 Di Blasio, C. J., A. C. Rhee, et al. Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol. 2005; 30(5):567-86. 7 Carlucci JR, Nabizada-Pace F, Samadi DB. Organ-confined prostate cancer and the emergence of robotic prostatectomy: What primary care physicians and geriatricians need to know. Geriatrics. 2009; 64(2):8-14.
  • 8 Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec; 68(6):1268-74.
  • 9 Merglen A, et al. Short- and long-term mortality with localized prostate cancer. Arch Intern Med 2007; 167:1944-1950.
  • 10 Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May; 99(5):1109-12. 11 Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology. 2004 May; 63(5):819-22. 12 Kaul, S, A Savera, K Badani, M Fumo, A Bhandari, M Menon. Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int. 2006; 97:467-72. 13 Tewari et al. Total reconstruction of the vesico-urethral junction, BJU international. 2008; 101, 871–877.
  • 14 Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May; 99(5):1109-12. 15 Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul; 164(1):242, 59. 16 Goeman L., Salomon L., La De Taille A, et al. Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol. 2006; 24, 281-288
  • 17 Buron C, Le Vu B, et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys. 2007; 67(3):812-22.
  • 18 Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007 Sep; 24;110(9):1951-1958. 19 Mottrie A, Van MP, De NG, Schatteman P, Carpentier P, et al. Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases. Eur Urol. 2007; 52:746–51. 20 Mikhail A, et al. Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology. 2006; 67(4): 774-9. 21 Ficarra V, Novara G, Fracalanza S, D'Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one european institution. BJU International. 2009; 104(4), 534-539
  • 22 Zelefsky M, Chan H, Hunt M, Yamada Y, Shippy A, Amols H. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. journal of urology.2006; 176 (4): 1415-1419 . 23 Merrick G. Erectile function after prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2005 Jun; 62(2): 437-47. 24 Sharifi N, Gulley J, and Dahut W. Androgen deprivation therapy for prostate cancer. JAMA. 2005 Jul; 294(2): 238 - 244. 25 Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology. 2004 May;63(5): 819-22.
  • Footnote :  *da Vinci®  Prostatectomy is the prostate cancer treatment course most often utilized in the United States.  Based on 2007 US procedure numbers and healthcare data, on file with Intuitive Surgical, Inc. Data on file includes information from Solucient® data from Thomson™ Healthcare, CaPSURE™ treatment database, and procedure numbers from Intuitive Surgical, Inc.
  • References Page
  • References Page

Precise, Minimally Invasive Prostate Cancer Removal Precise, Minimally Invasive Prostate Cancer Removal Presentation Transcript

  • David Lieber MD Springfield Clinic Urology Precise, Minimally Invasive Prostate Cancer Removal
  • What is the Prostate?
    • Male sexual gland
    • Adds nutrients and fluids for sperm
    • This fluid is added to sperm during ejaculation
    • Urethra (urine channel) runs through the middle of the prostate
    Testes Prostate Seminal Vesicles Rectum Bladder Urethra Photo sourced from: www.daVinciprostatectomy.com
  • What is Prostate Cancer
    • Abnormal cells growing out of control
    • Spreads and invades local tissues
    • Prostate Cancer…
      • Begins with a small tumor in
      • the gland
      • First spreads to the local
      • lymph nodes
      • Then spreads to the bony skeleton and other areas of the body
    Photo sourced from: www.daVinciprostatectomy.com
  • Prostate Cancer: Highly Prevalent
    • Prostate cancer is the most common non-skin cancer in America, affecting 1 in 6 men 1
    • Prostate cancer is the second most frequently diagnosed cancer in men, and the sixth leading cause of cancer death in men 2
    Photo sourced from: www.daVinciprostatectomy.com
  • Early Detection & Aggressive Treatment = Highly Survivable
    • 91% of prostate cancer diagnosed in the US is clinically localized 3
    • US 5-year survival rate is 99% vs. <80% for many other developed nations 4
  • Staging of Prostate Cancer
    • Prostate Specific-Antigen (PSA)
    • Digital Rectal Exam
    • Trans Rectal Ultrasound
    • Gleason Score
    • Bone Scan
    • +/- CT scan or MRI
    • Biopsy and TNM staging system
      • Tumor, Nodes, Metastases
    Photo sourced from: www.daVinciprostatectomy.com
    • Tumor cannot be felt
    • T1a – cancer found in ≤ 5% TURP specimen
    • T1b - cancer found in ≥ 5% TURP specimen
    • T1c – cancer found as a result of PSA elevation only
    Prostate Cancer – T1 Disease Photo sourced from: www.daVinciprostatectomy.com
    • Tumor can be felt during DRE (digital rectal exam)
    • T2a – felt on ≤ one half of one side of prostate
    • T2b – felt on ≥ one half of both sides of prostate
    • T2c – felt on both sides of prostate
    Prostate Cancer – T2 Disease Photo sourced from: www.daVinciprostatectomy.com
    • Cancer has spread beyond the prostate
    • T3a – extra capsular extension
    • T3b – tumor invades seminal vesicle(s)
    Prostate Cancer – T3 Disease Photo sourced from: www.daVinciprostatectomy.com
    • Cancer has invaded local organs/tissues
      • Bladder muscle
      • Pelvic side wall
    • May cause pain in joints and back
    Prostate Cancer – T4 Disease Photo sourced from: www.daVinciprostatectomy.com
  • What do my biopsy results mean?
    • Prostate cancer graded on appearance of cancer cells
    • Gleason grading system
      • Gleason grade ranges from 1 (least aggressive) to 5 (most aggressive)
    • Gleason score (2-10)
      • Most common cell grade (first) added to second most common cell grade, e.g., Gleason 7 (3+4)
    Gleason Grading Least aggressive Most aggressive Photo sourced from: www.daVinciprostatectomy.com 1 2 3 4 5
  • Prostate Cancer Treatment Options
    • When prostate cancer is believed to be localized, there are five common treatment options available to a patient:
      • Surgery to remove the cancerous prostate (radical prostatectomy)
      • Radiation of the cancerous prostate, through either external radiation or radioactive seed implants (radiation therapy or brachytherapy, respectively)
      • Freezing of the cancerous prostate (cryotherapy)
      • Hormonal therapy, which is non-curative and often done in conjunction with radiation therapy or cryotherapy
      • Observation (watchful waiting)
  • da Vinci ® Advantage for Prostatectomy
    • Effective cancer removal
    • Quicker recovery and return to normal urinary function
    • Better chance of preserving delicate nerve structures that responsible for sexual function
    Prostate posterior Neurovascular bundle and nerve branches
  • Why da Vinci ® for Prostatectomy? Precise, Minimally Invasive Cancer Removal
    • Enables Meticulous Dissection
      • Endowrist instruments for precise dissection
    • Provides Superior Visualization
      • 3D High Definition View
    • Allows Precise Suturing
    • Intuitive motion with tremor filtration & motion scaling
    Photos sourced from: www.daVinciprostatectomy.com
  • da Vinci Surgery is minimally invasive
    • Instruments of the da Vinci Surgical System are small and fit through tiny incisions
    Photos sourced from: www.daVinciprostatectomy.com
  • Surgery: Gold Standard Treatment for Localized Prostate Cancer
    • “Because the entire prostate gland is removed with radical prostatectomy, the major potential benefit of this procedure is a cancer cure in patients in whom the prostate cancer is truly localized.&quot; 
    • -- (2007 AUA clinical guidelines 3 )
  • Surgery: Confidence to Know Status
    • Up to 35% of tumors can actually be more aggressive than the pre-surgery assessment and biopsy results indicated 5
    • Choosing surgery can:
      • Enable easier detection of cancer recurrence through PSA monitoring after a radical prostatectomy than after radiation therapy 6
      • Preserve your treatment options if there is a recurrence 7
  • Long-Term Survival and Localized Prostate Cancer A study of 3,159 patients found that 15 years after treatment, those who had undergone radical prostatectomy had a 40% lower risk of death from prostate cancer than radiation patients. 8 Photo sourced from: www.daVinciprostatectomy.com
  • Surgery: Longer Survival vs. Any Other Treatment 9) Merglen A, et al. Short- and long-term mortality with localized prostate cancer. Arch Intern Med 2007; 167:1944-1950. Photo sourced from: www.daVinciprostatectomy.com
  • Long-Term Survivability Matters
    • Why should we be focused on just 10-year survival for older patients?
    • Average 65 year old can expect to live for 18.4 years (CDC 2007 estimates)
  • Clinical Concerns for Prostatectomy
    • Cancer Control – Margins
    • Urinary Control – Continence
    • Sexual Function – Potency
    “ The Big 3”
  • Precision Matters: Cancer Control 10 11 12 13 Effective Cancer Control Shown with da Vinci Surgery (T2 positive margins) Photo sourced from: www.daVinciprostatectomy.com
  • Precision Matters: Urinary Control 14 14 15 15 16 16 Faster Return to Continence with da Vinci
  • Precision Matters: Urinary Symptoms 17 17 17 17 Increased Pain with Radiation Photo sourced from: www.daVinciprostatectomy.com
  • Precision Matters: Cancer Control Several studies have shown that patients potent prior to surgery have experienced a high level of recovery of sexual function (defined as an erection sufficient for intercourse) within a year following da Vinci Surgery. 18 19 20 21 High Level of Sexual Function at 1 Year with da Vinci Photo sourced from: www.daVinciprostatectomy.com
  • da Vinci : Get Back to Your Life
    • As a minimally invasive treatment, da Vinci Surgery for prostate cancer offers numerous potential benefits compared to traditional open surgery.
    • Potential benefits include:
      • Shorter hospital stay 22
      • Significantly less pain 23
      • Less blood loss and fewer transfusions 24
      • Less scarring
      • Faster return to normal activities 25
  • Growth of robotic-assisted prostatectomy da Vinci ® Prostatectomy is the Number #1 treatment for Prostate Cancer in the U.S. Photo sourced from: www.daVinciprostatectomy.com
  • Clinical References
    • 1 http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.70619/k.446E/Risk_Factors.htm.
    • 2 http://www.cancer.org/downloads/STT/Global_Cancer_Facts_and_Figures_2007_rev.pdf
    • 3 Prostate cancer clinical guideline update panel. Guideline for the management of clinically localized prostate cancer: 2007 update. Linthicum (MD): American Urological Association Education and Research, Inc. 2007; 82.
    • 4 http://www.cancer.org/downloads/STT/Global_Cancer_Facts_and_Figures_2007_rev.pdf
    • 5 King CR, Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J. Cancer (Radiat. Oncol. Invest.) 2000; 90,305-311.
    • 6 Di Blasio, C. J., A. C. Rhee, et al. Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol. 2005; 30(5):567-86.
    • 7 Carlucci JR, Nabizada-Pace F, Samadi DB. Organ-confined prostate cancer and the emergence of robotic prostatectomy: What primary care physicians and geriatricians need to know. Geriatrics. 2009; 64(2):8-14.
    • 8 Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec; 68(6):1268-74.
    • 9 Merglen A, et al. Short- and long-term mortality with localized prostate cancer. Arch Intern Med 2007; 167:1944-1950.
    • 10 Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May; 99(5):1109-12.
    • 11 Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology. 2004 May; 63(5):819-22.
    • 12 Kaul, S, A Savera, K Badani, M Fumo, A Bhandari, M Menon. Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int. 2006; 97:467-72.
    • 13 Tewari et al. Total reconstruction of the vesico-urethral junction, BJU international. 2008; 101, 871–877.
    • 14 Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May; 99(5):1109-12.
    • 15 Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul; 164(1):242, 59.
    • 16 Goeman L., Salomon L., La De Taille A, et al. Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol. 2006; 24, 281-288
    • 17 Buron C, Le Vu B, et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys. 2007; 67(3):812-22.
    • 18 Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007 Sep; 24;110(9):1951-1958.
    • 19 Mottrie A, Van MP, De NG, Schatteman P, Carpentier P, et al. Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184 cases. Eur Urol. 2007; 52:746–51.
    • 20 Mikhail A, et al. Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology. 2006; 67(4): 774-9.
    • 21 Ficarra V, Novara G, Fracalanza S, D'Elia C, Secco S, Iafrate M, Cavalleri S, Artibani W. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one european institution. BJU International. 2009; 104(4), 534-539
    • 22 Zelefsky M, Chan H, Hunt M, Yamada Y, Shippy A, Amols H. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. journal of urology.2006; 176 (4): 1415-1419 .
    • 23 Merrick G. Erectile function after prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2005 Jun; 62(2): 437-47.
    • 24 Sharifi N, Gulley J, and Dahut W. Androgen deprivation therapy for prostate cancer. JAMA. 2005 Jul; 294(2): 238 - 244.
    • 25 Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes.
    • Urology. 2004 May;63(5): 819-22.
  • Appendix
  • Surgery vs. Surgery da Vinci Surgery vs. Traditional Surgical Approaches to Prostate Cancer da Vinci Surgery is the #1 Treatment Choice for Prostate Cancer. More men in the United States choose da Vinci Surgery than any other treatment option. 14 28) Outcome da Vinci Surgery Open Surgery Laparoscopic Surgery Cancer control       T2 margin status 2.51 5.92 7.73 Complications       Length of hospital stay 1.2 days 4 3 days 5 2.5 days 13 Major 1.7% 4 6.7% 5 3.7% 6 Minor 3.7% 4 12.6% 5 14.6% 6 Urinary function       3 month 92.9% 7 54% 8 62% 9 6 month 94.9% 7 80% 8 77% 9 12 month 97.4% 7 93% 8 83% 9 Sexual Function       12 month 86% 10 71% 11 76% 12
  • References: Surgery vs. Surgery
    • 1) Patel VR, Thaly R, Shah K.Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May;99(5):1109-12
    • 2) Scardino PT. Open Radical Retropubic Prostatectomy. Presented at the American Urological Association’s Carcinoma of the Prostate Course, San Francisco, California, Sept. 30 – Oct. 1 2005
    • 3) Touijer K, Kuroiwa K, Saranchuk JW, Hassen WA, Trabulsi EJ, Reuter VE, Guillonneau B. Quality improvement in laparoscopic radical prostatectomy for pT2 prostate cancer: impact of video documentation review on positive surgical
    • margin. J Urol. 2005 Mar;173(3):765-8. p. 766 (Results)
    • 4) Bhandari, A., McIntire, L., Kaul, S.A., Hemal, A.K., Peabody, J.O., and Menon, M. (2005). Perioperative complications of robotic radical prostatectomy after the learning curve. J Urol 174, 915-918.
    • 5) Brown, J.A., Garlitz, C., Gomella, L.G., McGinnis, D.E., Diamond, S.M., and Strup, S.E. (2004). Perioperative morbidity of laparoscopic radical prostatectomy compared with open radical retropubic prostatectomy. Urologic oncology 22,
    • 102-106.
    • 6) Guillonneau, B., Rozet, F., Cathelineau, X., Lay, F., Barret, E., Doublet, J.D., Baumert, H., and Vallancien, G. (2002). Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. The Journal of
    • urology 167, 51-56.
    • 7) Locke, DR, Klimberg IW and Sessions RP. Robotic Radical Prostatectomy With Continence And Potency Sparing Technique: An Analysis Of The First 250 Cases. Submitted To Journal Of Urology, Publication Date TBD. p. 5 table 4.
    • 8) Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul;164(1):242. p. 59 table 1.
    • 9) Goeman, L., Salomon, L., La De Taille, A., Vordos, D., Hoznek, A., Yiou, R., and Abbou, C.C. (2006). Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a prospective evaluation of 550 patients. World J Urol 24, 281-288.
    • 10) Kaul, S., Bhandari, A., Hemal, A., Savera, A., Shrivastava, A., and Menon, M. (2005). Robotic radical prostatectomy with preservation of the prostatic fascia: a feasibility study. Urology 66, 1261-1265.
    • 11) Parsons JK, Marschke P, Maples P, Walsh PC. Effect of methylprednisolone on return of sexual function after nerve-sparing radical retropubic prostatectomy. Urology. 2004 Nov;64(5):987-90.
    • 12) Su, L.M., Link, R.E., Bhayani, S.B., Sullivan, W., and Pavlovich, C.P. (2004). Nerve-sparing laparoscopic radical prostatectomy: replicating the open surgical technique. Urology 64, 123.
    • 13) Dahl DM, L’esperance JO, Trainer AF, Jiang Z, Gallagher K, Litwin DE, Blute RD Jr. “Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center.” Urology. 2002 Nov;60(5):859-63.
    • 14) Claim based upon U.S. data on file.