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Posts Tagged ‘robotic prostatectomy’

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Can you find me in Tootsie's eye...I'm there!

Can you find me in Tootsie’s eye…I’m there!

 

Prostate Diaries Most Popular Post with Over 50 Comments- Very Informative- Add Your Story for the Benefit of Others.

 

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Is your prostate cancer the same as your uncle Harry's. What does "most" mean? Is your prostate cancer like everyone else and are all prostate cancers the same? Hmmmmmmm?

Is your prostate cancer the same as your uncle Harry’s. What does “most” mean? Is your prostate cancer like everyone else and are all prostate cancers the same? Hmmmmmmm?

Well that depends on the definition of most is? Does 30,000 seem like a small number to you?

Prostate cancer is mostly slow growing. Yes. Prostate cancer usually affects the old. Yes. Most people die with it instead of – of it. Yes. Do young people die of it? Yes. Are men diagnosed young and are inoperable at the time of diagnosis too late to cure? Yes. What’s a man to do?

I humbly recommend that you look at the facts and numbers and not costs and epidemiological (is that even a word?) statistics when it comes time to make your prostate decisions. One in a hundred is 100% if it’s you!

So….which will you be? Hmmmmmmmmmmmmmmmm?         One of the 30,000?    You are a big boy…Are you fer it or agin it?

From “The Decision.”

 

Don’t be clever by half.

 On one particular occasion (however it has happened countless times) I had just told a patient that his biopsy showed cancer. I began to lay out an overview of the options and happened to start with surgery. Before I could continue, the patient told me, “My brother has a friend who has prostate cancer, and he did radiation because his doctor told him that if he had surgery he’d be impotent and that surgery lets air get to the prostate and will make it spread. My brother and his friend told me to steer clear of surgery.” A little knowledge – Don’t get too cute with what you’ve learned from your research; there is no reason to “go it alone” in making your decision.

Now, normally I will take a deep breath and slowly explain the pros and cons of both radiation and surgery and the concept of apples to apples, but sometimes I have a little fun showcasing the folly of how some patients will place so much credence on something someone has told them. On this occasion I said, “Mr. Jones, thank you for sharing that with me. What type of work does your brother do?” “He sells insurance.” “Thank you. And what type of work does your brother’s friend do?” “I think he builds houses.” I then said,” Okay. Based on what you have told me, this is what I’d recommend for your cancer. My advice to you would be for you to do what your brother said his friend was told by his doctor about your brother’s friend’s cancer. Do you have any other questions for me?”

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I occasionally respond to questions asked on the various message boards and one comment caught my eye this past week. The person on this particular board announced, ” I have decided to have my prostate removed with the cyberknife.” That’s some pretty effective marketing Harry!

CyberKnife to me sounds like you are cutting something. That it is ” robotically” controlled makes me think it may be something like a robotic prostatectomy.  Proton therapy sounds different from radiation therapy. Is it? ProstatRicision sounds to me like something is being cut. “Radiosurgically treating something seems to me that if you use the word “surgical” that there must be some sort of cutting going on. Using a robot to move the laparoscopic instruments to remove a prostate doesn’t seem much different from if a person was holding the laparoscopic instruments. (Whether the robot, the person using the laparoscopic instruments, or for that matter a surgeon using a knife, the prostate is removed and the consequence of that is the same regardless how or what or who takes out the prostate.) What’s a patient to do?

CyberKnife is radiation, to my knowledge there is no knife. A robotic arm guides the radiation treatment. CyberKnife robotic radiosurgery? What?

ProstaRicision is radiation. I don’t know what Ricision means….it sounds like excision, which is what surgery does.

I think protons are what are in radiation…I don’t know but I think it is just another form of radiation. To the proton therapy folks, at least they don’t make it sound like surgery.

The cartoon that I made about ” The robot got my prostate” is a sarcastic spoof about misunderstandings and myths regarding the DaVinci robot.

So……..read, take counsel in your urologist, radiation therapist, friends and family and make a decision that is right for you and for the right reasons. Don’t let the “marketization” of prostate cancer lead you down the wrong path.

In the horse race that is prostate cancer…..based on the above the surgical removal of the prostate by a surgeon utilizing the DaVinci Robot must be in the lead…..otherwise all of the other treatments would not be “implying” that there is surgery involved. And of course always remember….if a doctor, ad, website mentions cure…be wary.

One other thing….all the commercials and brochures have some guy bragging that he is back playing golf  soon after a particular therapy. The rubber meets the road long after the initial treatment of prostate cancer.

 In essence, from a perspective of the long-view, how someone is doing in the first two weeks of therapy is meaningless in the management of prostate cancer.

Oh…..you don’t follow?  You have homework to do.

CyberKnife Treatment For Prostate Cancer

04 Sep 2010

CyberKnife radiosurgery treatment for prostate cancer is rapid, effective and has no side effects, with the added benefit of being non-invasive. Since 2003, the CyberKnife Center of Miami and the CyberKnife Center of Palm Beach have been providing this high tech cancer treatment longer than any facility in South Florida.

Prostate Cancer is diagnosed in more than a quarter of a million men each year in the U.S. Treatment options in existence which are non-invasive with little to no side effects are practically none. CyberKnife treatment for prostate cancer as discussed in this video by James G. Schwade, M.D. executive director and Richard Boxer, M.D. provides an effective treatment overview. The CyberKnife treatment literally kills the cancer cells with a precisely targeted beam of radiation that does not affect surrounding tissue or organs.

CyberKnife Treatment requires:

– No incision

– No blood

– No anesthesia

– No pain

– No recovery or rehabilitation time

According to one prostate patient recently treated Mr. Lane Crosby of Florida, “My friends were all mad that I could go out and play golf and they couldn’t after their prostate cancer treatments.” Crosby was treated in Palm Beach Gardens in 5 treatments at the CyberKnife Center of Palm Beach.

Incorporating a compact, lightweight linear accelerator mounted on a robotic arm, the CyberKnife provides unparalleled flexibility in targeting tumors and lesions. Advanced image guidance technology tracks patient and target position during treatment, ensuring sub millimeter accuracy. The CyberKnife with its Dynamic Tracking Software is cleared by the FDA to provide radiosurgery for lesions anywhere in the body when radiation treatment is indicated. The CyberKnife has often been used to radiosurgically treat otherwise untreatable tumors or inoperable tumors. The system treats tumors at body sites unreachable by other stereotactic systems.

Source: CyberKnife

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a brent sharp

Dr. Sharpe received his bachelors degree in chemistry from the University of North Carolina at Charlotte in 1994. After obtaining his Medical Degree from East Carolina University School of Medicine in 2000, he completed a surgical internship at Texas Tech University, where he worked under Dr. Bernard Mittemeyer whose prostatectomy technique is the basis of today’s robotic prostatectomy. Dr. Sharpe completed his Urologic Residency at Emory University in 2005 and is board certified by the American Board of Urology.

Dr. Sharpe treats all urological conditions but has a special interests in prostate cancer, vaginal prolapse, kidney cancer, and erectile dysfunction. Prior to joining Northeast Georgia Urological Associates he was instrumental in expanding the minimally invasive treatment options and making these options more widely available to the patients of North Alabama. He was the area’s first and most experienced robotic surgeon, offering robotic surgery for kidney cancer, cystocele/pelvic prolapse, and kidney drainage reconstruction ( i.e. pyeloplasty ). He was also the first urologist in that area to perform complete laparoscopic procedures such as kidney radiofrequency treatment of renal tumors, pyeloplasty, and pure laparoscopic nephrectomy.

Northeast Georgia Urological Associates is pleased to have Dr. Sharpe join our treatment team and are excited to add his expertise in Urologic minimally invasive robotic surgery in serving our patients and the people of Northeast Georgia.

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Robotic prostate surgery rises, but results unclear

New York Times

Published Saturday, February 13, 2010


Dr. Jeffrey Cadeddu was trained to take out cancerous prostates by laparoscopy: making small incisions in the abdomen and inserting tools with his own hands to slice out the organ.

“Patients interview you,” said Cadeddu, a urologist at the University of Texas Southwestern Medical Center at Dallas. “They say: ‘Do you use the robot? Okay, well, thank you.’ ” And they leave.

Those patients want surgery by a robot, controlled by a physician not necessarily even in the operating room.

On one level, robot-assisted surgery makes sense. A robot’s slender arms can reach places human hands cannot. But robot-assisted prostate surgery costs more — about $1,500 to $2,000 more per patient. And it is not clear whether its outcomes are better, worse or the same.

One large national study, which compared outcomes among Medicare patients, indicated that surgery with a robot might lead to fewer in-hospital complications, but that it might also lead to more impotence and incontinence. But the study included conventional laparoscopic surgery patients among the ones who had robot-assisted surgery, making it difficult to assess its conclusions.

It is also not known whether robot-assisted prostate surgery gives better, worse or equivalent long-term cancer control than the traditional methods, either with a 4-inch incision or with smaller incisions and a laparoscope.

Meanwhile, marketing has moved into the breach, with hospitals and surgeons advertising their services with claims that make critics raise their eyebrows.

Robot-assisted prostate surgery has grown at a nearly unprecedented rate. Last year, 73,000 American men — 86 percent of the 85,000 who had prostate cancer surgery — had robot-assisted operations, according to the robot’s maker, Intuitive Surgical. Eight years ago there were fewer than 5,000, Intuitive says.

Dr. Sean Tunis, director of the Center for Medical Technology Policy, a nonprofit group that evaluates medical technology, said few other procedures had made such rapid inroads in medicine.

Still, a situation like robot-assisted surgery illustrates how patients may end up making what can be life-changing decisions based on little more than assertive marketing or the personal prejudices of their surgeon.

“There is no question there is a lot of marketing hype,” said Dr. Gerald Andriole Jr., chief of urologic surgery at Washington University. Andriole performs laparoscopic prostate surgery, and although he tried the robot, he went back to the old ways.

“I just think that in this particular instance, with this particular robot,” he said, “there hasn’t been a quantum leap in anything.”

But Cadeddu has now begun offering robot-assisted surgery to those who want it. “The battle is lost,” Cadeddu said. “Marketing is driving the case here.”

My thoughts_

I really don’t have a feel for which way this trend will go long term.  The inference is that it will continue on and that the only prostatectomies done will be with the robot. Unless….patients begin to see the limited long term advantage of the robot vs. the open method and hospitals/insurance companies begin to look more closely at the costs. As a rule, not true for all but for most, the robotic method takes longer to perform, meaning more operating room time, more anesthesia time and more other associated expenses. Another thing is happening and this has happened in other specialties and other organs as well. As more and more urologists are trained on the robot and use it exclusively, they will be come less experienced in performing the open method. So the new urologists won’t be able to do the open, the old guys can’t do the robot. It is a “brer rabbit” scenario for both. The very thing that the robotic surgeon doesn’t want is to have to open the patient for whatever reason during a robotic case, leaving what he is comfortable with to doing something he is not. I was speaking to a urologic resident that is interviewing for jobs and he told me that in his four years at his resident program he’d only seen four open prostatectomies. All the young guy’s coming out will need an old guy somewhere nearby, I would think, to be available if a robotic case converts to open. Curious times- all the patients want something that costs more and does not impact what is really important in the surgical management of prostate cancer,that is, cure, potency and continence.

Remember an experienced open guy is better than an inexperienced robotic guy… and vice versa.  A fool with a tool is still a fool.

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