Zytiga: A New Late-State Prostate Cancer Option
Written on 23 September 2011 by RoboticOncology.comOn top of the wealth of prostate cancer articles during Prostate Cancer Awareness Month, this week we learned of the launch of Zytiga in the U.K. Already approved here in the U.S., Zytiga is a relatively new drug treatment for men with advanced, aggressive prostate cancer.
Men who have what is referred to as mestastic castration-resistant prostate cancer have already undergone some combination of chemotherapy, radiation and other types of testosterone-lowering treatments. For these patients, such treatment modalities have not been successful. Zytiga works by inhibiting the prostate cancer tumor’s supply of testosterone from within the tumor. Without testosterone, the tumor cannot continue to grow.
A recent study of 2,000 men across 13 countries indicated success with this new drug, giving men an additional 5 months of life when taken daily in conjunction with prednisone. Of criticism, though, is the drug’s price. A monthly supply can cost as much as $5,000.
At a time when healthcare costs are scrutinized nationwide, talk of expense seems to go hand-in-hand with each new development. Robotic surgery, too, is often questioned for the expense to the hospital in purchasing and maintaining equipment. Rather than dismiss a treatment option on the grounds of cost, we need to look at each patient individually and do our best to treat the cancer quickly and efficiently.
As I continue to urge men to have annual PSA screenings, I believe there’s an important point to be stressed about detecting and treating prostate cancer early. This new drug is no doubt an important breakthrough to men with late-stage prostate cancer. But what I believe to be the real goal is eliminating the need for any late-stage cancer treatment. We must continue focusing our efforts on early detection, followed by a treatment method such as robotic prostatectomy that will eliminate the cancer.
In doing so, we can give men the opportunity for another 20 or 30 years of active, enjoyable life, rather than a mere five. Again, I believe Zytiga has great merit for certain patients. I simply believe that we need to do a better job of preventing patients from an ongoing struggle with this progressive disease.
Untreated prostate cancer takes a toll not only on our healthcare system but, more importantly, on the lives of our patients and their families.
It’s still Prostate Cancer Awareness Month. Get your PSA screening on your calendar. Don’t wait.
Save This PageProstate Cancer Treatment: Match Between HIFU And Robotic Prostate Surgery And The Winner Is?
Written on 15 September 2011 by RoboticOncology.comThe good news about prostate cancer is that the medical community continues to work toward new and improved treatment options. With a quick Google search you can find hundreds of articles and web sites full of prostate cancer treatment options. Some are factual, based on sound research and medical expertise while others are more embellished and opinion based. Often it can be difficult to weed through the clutter and pull out dependable information on which to base your treatment decisions.
I’d like to share my recent concern about the way in which one treatment option is being sold. HIFU, which stands for High Intensity Focused Ultrasound, is a non-FDA-approved method for treating localized prostate cancer. During the procedure, a rectal probe sends an ultrasonic beam of sound waves to the cancerous prostate. The beam heats and destroys the cancerous tissue, which is later urinated out.
Some web sites offer very factual, concise information about HIFU, its risks and benefits. One, in particular, however spends a great deal of time attacking robotic radical prostatectomy. Using phrases such as “limp and leaking” or warning men about the negative impact that prostatectomy surgery will have on their marriage. This seems to me to be counter to the united goal of the medical community to offer support and proven treatment and cure options. Rather than discussing HIFU successes, they focus on your trip to Cancun, Bermuda or the Bahamas for the procedure with pictures of blue waters and tropical excursions.
One analogy suggests that robotic prostatectomy surgery is like playing Russian Roulette. On the contrary! Prostatectomy is the one, true way for a doctor to plainly see the extent of the cancer. During robotic surgery I have a clean, clear view of the prostate and everything surrounding it. No amount of testing can give us as full a picture of the cancer staging before surgery. What is believed to be localized prostate cancer could actually be found to be more extensive during and after the surgery. I don’t approach patient education this way, but it could be argued that choosing an option besides surgery is Russian Roulette. Surgery is the only way to see that the cancer is fully removed. My patients have a 97% cure rate. Earlier this year, a ten-year American Urological Association (AUA) study found an 83% success rate with HIFU.
With regard to urinary continence and sexual function, my SMART (Samadi Modified Advanced Robotic Technique) surgery is a unique approach that allows me to preserve both. In most circumstances, you will be able to have sex with your wife. It’s highly likely that you’ll be able to control your urine over time. I don’t perform robotic prostatectomy surgery to boost my ego. I do it to help men live long, fulfilling lives.
HIFU may have appropriate application with some patients, but it is not FDA-approved and it does not give visual proof that all cancer has been removed. HIFU is still considered an experimental procedure in the United States. Robotic radical prostatectomy is a sound, proven treatment option for the elimination of prostate cancer.
Be wary of finding a medical miracle on a sandy beach. My goal is not to offer you a luxurious vacation and a quick fix. Strongly consider the benefits of minimally invasive robotic radical prostatectomy and whether it is right for you. The peace of mind that comes after surgery is priceless. And then you can take a tropical vacation with your wife to celebrate your happy marriage and your cancer-free life.
Save This PageBone Scans and CT Scans for Prostate Cancer Patients
Written on 6 September 2011 by RoboticOncology.comAs we talk more about early prostate cancer screening this month, it’s helpful to understand more about the diagnostic process. Following the detection of an elevated PSA level, patients typically move on to a prostate biopsy. Once the biopsy confirms the presence of prostate cancer, a doctor must then determine the extent of the cancer. Is it localized in the prostate or has it spread to other areas of the body? If it hasn’t yet spread, how high-risk is the cancer? Is it likely to spread?
Using the Gleason grading system, doctors use biopsy results to score the differences in a patient’s prostate cell patterning compared to that of a cancer-free prostate. The score is meant to indicate how likely the cancer is to grow or spread: 2-6, not very likely; 7, moderate; and 8-10, highly likely.
Recently, much news has been made of how doctors choose to use bone scans and CT scans as the next step in evaluating prostate cancer in a patient. The American Urological Association (AUA) guidelines indicate that only high-risk prostate cancer patients should go on to have bone or CT scans; however, this is not always the case. Studies indicate a fairly high incidence of scans even for patients whose risk is low to moderate.
From 2004-2005, researchers examined U.S. Medicare prostate cancer patients to compare CT scan usage relative to prostate cancer risk. Surprisingly, roughly 30% of low-risk patients and close to 50% of moderate-risk received scans. I believe this is due, in part, to the fact that we as prostate cancer specialists, are eager to learn as much as we can about a patient’s health and the state of their cancer. Over-testing can occur during the course of a prostate cancer patient’s care. The guidelines set forth by the AUA are very important; they’re in place primarily to help manage healthcare expenses and mitigate patient overexposure to radiation. Though, equally important is the need to treat each patient individually. Perhaps more surprising about this study is the fact that approximately 40% of high-risk patients did not receive CT scans. The reason for this is not disclosed in the findings.
What we’re also learning about the use of scans in prostate cancer patients is that, like treatment techniques and expertise, testing varies greatly from one doctor to another. In 2009, a second study looked at 150 urologists across four states to determine how the guidelines and information from colleagues might affect the use of scans in prostate cancer patients. Of the 858 patients, 31% received bone scans and 28% had CT scans. The study saw significant drops in these numbers after the doctors were reminded of industry guidelines, and again after sharing scan results across physicians. It stands to reason that the more collaboration and information in the prostate cancer arena, the better the patient care. In my mind, Prostate Cancer Awareness month is as much about educating the community as it is about getting the experts talking to each other.
The more I can learn about a patient’s prostate cancer, the better I can treat it. PSA and DRE screening, biopsies and Gleason scores are all part of our prostate cancer arsenal. And, when needed, bone scans and CT scans are vital, as well. I am confident that testing procedures and screening tools will continue to improve and our evaluation methods will continue to be enhanced. The fact remains, however, that until I see the prostate cancer first-hand, during a robotic prostatectomy, I cannot exactly determine its extent. No one can. That is why I continue to recommend that men with localized prostate cancer move forward with a radical, robotic prostatectomy.
Save This PageProstate Cancer Awareness Month Brings News of More Precise Prostate Cancer Screening on the Horizon
Written on 1 September 2011 by RoboticOncology.comEven better than discussing the benefits of early prostate cancer screening, is the fact that I can share some promising news about advancements in our testing resources. This month, Urology will publish the findings of a three-hospital study on a new urine-based prostate cancer test created by AnalizaDX, Inc., a Cleveland-based biotech company. Hospitals in Cleveland and Boston performed the test on 222 men, finding significant improvements in results accuracy.
Currently, the blood PSA (Prostate-Specific Antigen) test evaluates PSA levels in men on the basis that elevated levels indicate the potential presence of prostate cancer. Unfortunately, the current test can produce less-than-ideal false results. False negatives are believed to result from 15% of PSA tests and false positives 55-75% of the time. A false positive can put a patient on an unnecessary emotional rollercoaster and usually results in unneeded biopsies, as a positive test cannot be ignored. Obviously, false negatives can have much greater implications. While our current PSA screening method is truly invaluable, improvements would certainly be welcome.
As an assay, the new PSA/SIA screening is believed to be more accurate. The findings showed a 100 percent sensitivity, meaning no false negatives were reported. Further, an 80 percent specificity was shown; this is a drastic reduction in false positives currently seen. Its advantages are believed to stem from the fact that this new urine-based test evaluates a vast range of ultra-structural changes in the PSA (Prostate-Specific Antigen) protein, rather than just looking at a patient’s PSA level. Initial results indicate the test’s ability to decipher between the molecular structures of cancerous cells vs. non-cancerous cells by finding microscopic structural differences.
Currently, men with a high PSA reading are referred for biopsy. Though not inline with my medical opinion, many men with elevated PSA levels and positive biopsies choose to wait out their prostate cancer and look for signs of advancement, in symptoms and/or later screenings. This new PSA/SIA test is also believed to have the ability to assist prostate cancer experts with staging and advancement determinations. If so, I believe we could have fewer men waiting and more men acting. The presence of prostate cancer should not be put on hold; in most cases it should be dealt with through radical, robotic prostatectomy surgery. If we can use this test to more accurately qualify a man’s prostate cancer, surgical decisions may be clearer to a reluctant patient or doctor.
So this month, remember your PSA test. It is still our best line of defense against prostate cancer. I’m hopeful that continued research on the PSA/SIA will show the same great results it has thus far, and perhaps this time next year I’ll be encouraging you to seek it out.
Save This PageProstate Cancer Urine Test on the Horizon
Written on 29 August 2011 by RoboticOncology.comThere is promising new research in the area of prostate cancer detection that I’d like to share with you. As you know, Prostate Specific Antigen (PSA) screening is the universal standard for early detection of prostate cancer in men. I, along with my colleagues in the medical community, routinely stress the need for men to begin PSA testing at the age of 50. For men considered high risk, including African Americans or those with a genetic history of prostate cancer, that age bumps up to 40. Early detection is the best way to beat prostate cancer.
Researchers at the University of Michigan are now exploring the use of a urine test to aid in the detection of prostate cancer. The test is designed to identify two genetic markers in men: TMPRSS2:EG and PCA3. Both bio-markers are known to be present in prostate cancer patients. The first, caused by two genes switching places and then fusing together, is believed by some to be the cause of prostate cancer, but it is only found in about half of cancer patients. To strengthen the test, the detection of the second marker, PCA3, is included. The recent study looked at 1,312 men with elevated PSA level and subsequent prostate removals, comparing the results of their urine tests with the results of their biopsies. Based on the correlations found in the results of each, researchers believe the test may be an effective tool in detecting a man’s prostate cancer risk.
Further, what the makers and researchers of the new urine test hope to achieve is the ability to stratify, or categorize, the level of a man’s risk of prostate cancer. Prostate cancer biopsies in the U.S. exceed one million annually. If a test such as this can show a man’s risk of prostate cancer to be very minimal, a biopsy may be postponed. Similar tests of these two genetic markers have been performed in the past and there is some evidence that combining such a test with the PSA blood test may result in a better prediction of prostate cancer. That being said, I believe great caution must be used with its integration into prostate cancer screening.
Erring on the side of caution is always best. In dealing with my prostate cancer patients, I would much rather perform a biopsy and deliver peace of mind to a man than be too conservative in my approach. Prostate cancer is a silent killer that does not step gingerly. I believe it should be treated with the same force that it treats us. Early detection and early removal is my firm approach. But what encourages me about research like this is the potential to strengthen our prostate cancer detection abilities.
Unfortunately, African American men who are among the highest at risk of prostate cancer were not included in this study. African American men are three times as likely to be diagnosed with prostate cancer as their non-Hispanic Caucasian counterparts. I’m hopeful that research will soon be conducted on the effectiveness of genetic marker urine testing on this critical part of our population.
This new urine test, to be produced by Gen-Probe, is not yet available to the public, nor has it been submitted for FDA approval yet. The University of Michigan will soon be offering the test and, I believe, its effectiveness will be made clearer in the coming months and years.
Save This PageBone Scans and CT Scans for Prostate Cancer Patients
Written on 26 August 2011 by RoboticOncology.comAs we talk more about early prostate cancer screening this month, it’s helpful to understand more about the diagnostic process. Following the detection of an elevated PSA level, patients typically move on to a prostate biopsy. Once the biopsy confirms the presence of prostate cancer, a doctor must then determine the extent of the cancer. Is it localized in the prostate or has it spread to other areas of the body? If it hasn’t yet spread, how high-risk is the cancer? Is it likely to spread?
Using the Gleason grading system, doctors use biopsy results to score the differences in a patient’s prostate cell patterning compared to that of a cancer-free prostate. The score is meant to indicate how likely the cancer is to grow or spread: 2-6, not very likely; 7, moderate; and 8-10, highly likely.
Recently, much news has been made of how doctors choose to use bone scans and CT scans as the next step in evaluating prostate cancer in a patient. The American Urological Association (AUA) guidelines indicate that only high-risk prostate cancer patients should go on to have bone or CT scans; however, this is not always the case. Studies indicate a fairly high incidence of scans even for patients whose risk is low to moderate.
From 2004-2005, researchers examined U.S. Medicare prostate cancer patients to compare CT scan usage relative to prostate cancer risk. Surprisingly, roughly 30% of low-risk patients and close to 50% of moderate-risk received scans. I believe this is due, in part, to the fact that we as prostate cancer specialists, are eager to learn as much as we can about a patient’s health and the state of their cancer. Over-testing can occur during the course of a prostate cancer patient’s care. The guidelines set forth by the AUA are very important; they’re in place primarily to help manage healthcare expenses and mitigate patient overexposure to radiation. Though, equally important is the need to treat each patient individually. Perhaps more surprising about this study is the fact that approximately 40% of high-risk patients did not receive CT scans. The reason for this is not disclosed in the findings.
What we’re also learning about the use of scans in prostate cancer patients is that, like treatment techniques and expertise, testing varies greatly from one doctor to another. In 2009, a second study looked at 150 urologists across four states to determine how the guidelines and information from colleagues might affect the use of scans in prostate cancer patients. Of the 858 patients, 31% received bone scans and 28% had CT scans. The study saw significant drops in these numbers after the doctors were reminded of industry guidelines, and again after sharing scan results across physicians. It stands to reason that the more collaboration and information in the prostate cancer arena, the better the patient care. In my mind, Prostate Cancer Awareness month is as much about educating the community as it is about getting the experts talking to each other.
The more I can learn about a patient’s prostate cancer, the better I can treat it. PSA and DRE screening, biopsies and Gleason scores are all part of our prostate cancer arsenal. And, when needed, bone scans and CT scans are vital, as well. I am confident that testing procedures and screening tools will continue to improve and our evaluation methods will continue to be enhanced. The fact remains, however, that until I see the prostate cancer first-hand, during a robotic prostatectomy, I cannot exactly determine its extent. No one can. That is why I continue to recommend that men with localized prostate cancer move forward with a radical, robotic prostatectomy.
Save This PageTomatoes and Broccoli: Part of Your Prostate Wellness
Written on 17 August 2011 by RoboticOncology.comThere is a lot to read about the benefits of certain foods in the prevention and treatment of prostate cancer. Prominent among these “super foods” are tomatoes and broccoli. Tomatoes are rich in the antioxidant lycopene and broccoli is stacked with sulforaphane.
Many studies indicate that a diet high in lycopene can reduce the risk of prostate cancer, while others report the benefits of lycopene in slowing the development of prostate cancer cells in newly diagnosed men. Just last month, Oregon State University issued the results of a study focused on African American men that indicates the sulforaphane found in broccoli can destroy prostate cancer tumors while preserving healthy cells. There have even been studies conducted on the benefits of eating tomatoes and broccoli together.
I am very happy to see on-going research in all areas of healthy food consumption. We don’t know everything there is to know about how specific fruits and vegetables positively impact prostate cancer cells and other cancer development. But, we do know that with a wellness lifestyle of both healthy eating and exercise, the body is better equipped to fight infection and disease. These are the easiest first steps for men to take. This is particularly true since obesity can pose a significant increase in men and their risk of developing prostate cancer, and can make prostate cancer surgery more complex.
I am also encouraged to see prostate cancer research focused on African American men, as statistics show them to be at increased risk of developing the disease. Understanding new research and arming ourselves with a well-nourished, healthy immune system are among the best things we as men can do to prevent prostate cancer.
But please do not forget that prostate cancer prevention must include vigilance. I urge men over age 50 to get PSA (Prostate-Specific Antigen) screenings annually. And high-risk men – African American men and those with genetic components increasing their risk of prostate cancer– must do so annually over age 40. These screenings ensure early detection of prostate cancer.
I believe that the combination of early detection and removal of the prostate through robotic prostatectomy once the cancer is detected is the key to eradicating prostate cancer. But let’s start before we even get to a diagnosis. Your focus on a healthy lifestyle now can lead to overall wellness long into your future and may even help you avoid prostate cancer.
Save This PageSex After Prostate Surgery
Written on 10 August 2011 by RoboticOncology.comMen facing prostate cancer experience a wide range of emotions and fears about treatment, survival and cure. Robotic prostatectomy procedures, performed to remove the prostate gland and all surrounding cancer, provides very good results but can add to the fears that men have. Primarily, men want to know if they will be able to have and enjoy sex after prostate cancer treatment.
Prior to the advent of laparoscopic and robotic techniques to remove the prostate gland, open, abdominal surgery was the standard. During these procedures, it was very difficult for the surgeon to see the tiny nerves responsible for erectile functioning and they were often severed unintentionally. As a result, men typically experienced changes in their ability to have sex after prostate removal. Today, robotic radical prostatectomy provides the surgeon with a magnified view of the prostate gland, along with increased precision and dexterity, greatly reducing the risk of damage to nerves vital to erectile functioning.
Dr. Samadi maintains that prostate surgery recovery means a return to the patient’s normal quality of life. “I consider robotic surgery successful when the cancer is cured and the patient has full continence and potency. All three criteria must be met for me to consider the surgery a success.” Dr. Samadi employs a start-to-finish approach, including individualized evaluation of sexual function prior to radical prostatectomy and assessment of options to aid in the return of sexual function after prostate surgery.
Robotic radical prostatectomy using the da Vinci Surgical System is the commonly recommended treatment for men with localized prostate cancer. The da Vinci system’s greatly magnified visualization and sensitive electronics permit Dr. Samadi to perform highly precise movements at the surgical site. This allows for cleaner removal of the cancerous tissue and results in overall superior clinical outcomes when compared to open and laparoscopic prostatectomy procedures. Using his own SMART (Samadi Modified Advanced Robotic Technique), Dr. Samadi is able to spare the nerves critical for sexual function. Prostate surgery recovery is then faster, with an improved outlook for regaining the ability to have sex after prostate removal. SMART surgery also mitigates the risks associated with incontinence after prostate surgery.
The resumption of sexual potency can take up to 12 months, or longer depending on the complexity of the prostatectomy surgery. It’s not uncommon for men to experience ED after prostate surgery, particularly during the weeks immediately following the procedure. However, this is not an indication of the long-term sexual potency of a patient. On-going post-operative communication is part of Dr. Samadi’s comprehensive approach to ED after prostate cancer treatment.
Save This PageProvenge Later vs. Robotic Prostatectomy Now
Written on 13 July 2011 by RoboticOncology.comThis week Medicare announced that it will continue to pay in full for the use of Provenge in treating prostate cancer when used in accordance with label indications. Provenge is a relatively new, FDA-approved drug used for patients with advanced prostate cancer. Unlike immunotherapy or chemotherapy, it uses a patient’s own cells to fight the cancer. Over a series of three procedures, cells are removed from the prostate cancer patient, “trained” in a lab, and then reintroduced in the patient in hopes that the body will attack the cancer like an infection. Provenge is reporting success in patients who are able to extend their lives with minimal side effects.
There are two main concerns I have with the use of drugs such as Provenge. First and foremost, this is a late game effort. Most prostate cancer patients using Provenge are doing so because earlier treatments failed or because their “watchful waiting” led them too far in their cancer’s progression. I don’t want my patients to reach this stage in prostate cancer treatment. From the moment men are diagnosed with prostate cancer, I want to help them make decisions that will remove prostate cancer from their lives for good. I believe that my experience in robotic prostatectomy procedures and my SMART (Samadi Modified Advanced Robotic Technology) surgery can help do this.
Prostate cancer is often referred to as the silent killer. Nearly symptomless, prostate cancer can develop, and progress significantly, in patients without their knowledge. For that reason, the key to eradicating prostate cancer is to start early – test early, treat early. Early detection of prostate cancer buys valuable time. Watchful waiting may waste that time, especially since studies indicate that in post-surgery biopsies many patients’ prostate cancer was actually far more advanced than initial staging tests indicated. And patients who do decide to treat their prostate cancer, but with less-aggressive options, may face a lifetime of worry and additional treatments. Robotic surgery removes the prostate and all surrounding cancer. Other treatments may not provide such concrete results.
Second, as the United States is on the brink of healthcare reform, I worry that focusing on high-priced drugs like Provenge (estimated to cost $93,000 per patient) distracts from healthcare efficiencies. The most efficient way to manage cancer patients of all types is to provide the method of treatment that leads them most directly to the best possible cure rate. Naturally, this varies by patient and by type of cancer. In my opinion, robotic prostate surgery is an early, aggressive way to remove cancer from the body and eliminate the need for a lifetime of costly treatments, drugs and care.
So, while Provenge may be doing very good things for certain patients, patients should never be faced with taking a drug that will buy them a year or two; not when they can act early to remove prostate cancer from their lives.
Save This PagePositive Quality of Life After Prostate Cancer Treatment
Written on 11 July 2011 by RoboticOncology.comI’ve written before about the positive results my patients are experiencing post-prostatectomy, but in light of a new study released this month I’d like to remind patients of my position. It’s no secret that once men learn of their prostate cancer and its treatment, their immediate thoughts are of how it will affect their quality of life. The Internet is rich with research providing accounts of those recovering from prostate cancer and the negative affects it can have on continence and erectile function. But as my statistics indicate, this does not have to be the case. As new research continues to pour from institutions across the world, the findings must be interpreted carefully.
The study recently published in the August 2011 Journal of Urology reveals that of 152 men surveyed one year post-surgery, only 36 percent indicated that their initial expectation for urinary function matched their true results, and only 40 percent said so of sexual function. At first glance, these numbers are less than stellar, but read on. While about half of those surveyed expected urinary and sexual function to return to normal, a surprising 17 percent expected improved sexual function.
Unfortunately, the survey report lacks details about the type of surgery performed – laparoscopic or robotic. Additionally, pre-surgery counseling was provided, but the researchers do not indicate the type or depth of the counseling. In questioning the findings of this study I am not discounting the fact that continence and sexual function can be negatively impacted by prostatectomy. Therefore, the choices you make regarding your treatment and your surgeon are critical. Saving the lives of those affected by prostate cancer is my charge in life, but that does not make me a miracle worker per se.
My SMART (Samadi Modified Advanced Robotic Technology) surgery provides enhanced vision and more precise angles of dissection during surgery allowing me, in most cases, to remove the prostate while sparing the nerves surrounding it. This reduces the risk of damaged nerve bundles and arteries critical to blood flow. As a result, 96 percent of my patients regain urinary control and 87 percent regain sexual potency within 12 to 24 months.
I realize that, for most of you, success is not measured in cure alone. Prostate cancer treatment will always be determined on an individual basis, but I believe my vast experience coupled with my robotic technology expertise can lead patients to a promising post operative recovery and fulfilling life.
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