Bladder Cancer Basics: What You Should Know

Written on 26 November 2012 by

Try as you might, you cannot ignore the symptoms of an irritated bladder. The frequent urge to go, burning while urinating, pain while urinating, pelvic pain, back pain, and especially blood in the urine can all be signs that something’s not right. Each of these symptoms requires medical attention – whether the result of a simple bladder infection, urinary tract infection, or something more serious like bladder cancer.

Urinary symptoms aren’t necessarily cause for alarm, but since bladder doesn’t always give us warning, it’s best to take symptoms seriously. The good news is that, like prostate cancer, bladder cancer can be effectively treated through robotic surgery.

Using the da Vinci Surgical System, I perform robotic cystectomy to remove part of the bladder or the entire bladder, and even the surrounding lymph nodes and organs when necessary. As with prostate cancer, robotic surgery can improve recovery results and provide realtime diagnostic confirmation of the extent of the disease. Whether or not male or female reproductive organs must be removed can be expertly determined during the procedure thanks to the enhanced surgical view.

Some important bladder cancer facts to keep in mind:

1) Radiation risk. Prostate cancer radiation is associated with an increased risk of bladder cancer*. When selecting a prostate cancer treatment, this should be carefully explored. There is no evidence that robotic prostatectomy surgery increases risk of bladder cancer.

2) Watch your urine. Painful urination and blood in urine require medical attention, but you might not get such a vivid warning of bladder cancer. Blood can be present in urine without being visible to the naked eye so don’t wait till you see it if you think there’s an issue. Any urinary discomfort or changes in urine flow should be explored through urinalysis. If further exploration is needed, a urine cytology will be used for microscopic evaluation.

3) Smoking causes many cancers. Smoking is the number one cause of bladder cancer and it doubles your risk of developing the disease. Other bladder cancer risk factors include a family history of the disease and consistent exposure to certain chemicals.

4) Chronic urinary infections. Repeat bladder infections or urinary stones could indicate a more significant problem. A cystoscope allows for a thorough exploration and biopsy of the bladder to check for the presence of cancer.

5) Preventing bladder cancer. What your bladder processes each day does matter. Stay hydrated and reduce your fat and cholesterol intake.

The surgical improvements afforded by robotics are instrumental in the success of my SMART (Samadi Modified Advanced Robotic Technique) prostate removal surgery and my bladder cancer surgery. Robotic-assisted cystectomy can improve bladder cancer removal rates by 14% and my nerve-sparing technique helps restore sexual potency in just 11 months after the procedure.

The surgical world of urinary oncology continues to be improved through robotics, experienced surgeons, and educated patients.

* According to a 2008 study conducted at the University of Miami Miller School of Medicine




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Movember Prostate Cancer Take-Away

Written on 21 November 2012 by

Movember has taken the world by storm and ’stache. Each November it is a great pleasure to watch the world come together, turning a global eye toward prostate cancer, testicular cancer, lung cancer, and a host of other men’s health issues.

The other 11 months of the year, men go about their days blissfully unconsumed with their health. Rarely do men gather round the table, coffee in hand, discussing their wellness woes. They don’t call friends with a quick question about their urine or to share how their back feels. Boasting of sports-induced aches and pains is about as far as the sharing goes.

That said, Movember gives us all a great excuse to share, remind, and ultimately save. Wives and daughters have an opening to prod about what normally goes unmentioned. Men have an invitation to tell their sons and even their friends the truth about their prostate cancer journey; to share first-hand the importance of screening and treatment choice.

As Movember draws to a close, I acknowledge that men are likely to button-up about their prostates once again. My hope is that the month of talk turns into a year of action. As you say goodbye to your mustache, let your daily shave remind you of these important prostate cancer facts:

• The risk of developing prostate cancer doubles with a family history of the disease
• African American men are 60% more likely to get prostate cancer than Caucasian men
• Obesity increases your risk of prostate cancer death by 33%
• Annual PSA blood tests have reduced the prostate cancer mortality rate by 40%
• Start annual PSA tests at age 50 – or 45 if you’re considered high risk
• Robotic prostatectomy surgery is the most definitive treatment for prostate cancer
• Dr. Samadi has successfully removed more than 4,000 cancerous prostates through his Samadi Modified Advanced Robotic Technique (SMART) surgery
• With SMART 96% of patient regain urinary continence and 85% regain sexual function*

May your mustache memories keep you alive and well.

* The benefits of robotic surgery cannot be guaranteed as surgery is both patient and procedure specific. Previous surgical results do not guarantee future outcomes.




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Viagra And Sex After Prostate Cancer

Written on 8 November 2012 by

While the use of Viagra (sildenafil) has become fairly mainstream, most men would certainly opt for the sexual potency to go without it. Whether man-to-man or patient-to-doctor, many Viagra discussions are initiated with, “Will I need Viagra after prostate cancer?” The answer, I believe, may be found in the treatment path a man chooses.

Erectile dysfunction (ED) after prostate cancer is a common concern and much can be read about sexual potency after prostate cancer treatment. Viagra is effective in helping men achieve erections after prostate cancer, but the duration of use may be directed by the treatment. My SMART (Samadi Modified Advanced Robotic Technique) procedure yields sexual potency in 85% of men just 12-24 months after surgery.

Some men are comfortable assuming Viagra will save the day regardless of treatment choice or outcome. Others focus on selecting a treatment path, such as robotic prostatectomy, that is more likely to deliver a natural sex life after prostate cancer.

A recent study at Memorial Sloan-Kettering Cancer Center found improved sexual function in men who took Viagra before, during, and after radiation therapy; however, the length of time Viagra is needed requires further study.

This is an important distinction for men and their partners to consider. With SMART surgery men tend to experience continued improvement in their sexual potency in the weeks and months following surgery. Short-term use of Viagra can help. In contrast, sexual potency after radiation does not typically improve with time and Viagra or other ED treatments may be required long-term or permanently.

The hope for all men is that spontaneous erections are fully restored but many factors outside of treatment choice, such as age and prior erectile function, also play a role.

Viagra and other similar medications can be useful tools for penile rehabilitation after prostate cancer. But Viagra doesn’t work for everyone and it may not be safe for everyone, especially those with heart conditions.

I work closely with patients and their partners during every phase of prostate cancer treatment and recovery. As needed, I assist men with ED medication and even penile implant referrals, should potency issues remain.




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Enlarged Prostate: What is it? What are the treatments?

Written on 23 October 2012 by

The enlarging of the prostate gland occurs naturally as men age. Unfortunately, this process can press on the urethra and result in nuisance side effects including urination and bladder problems. The good news is that an enlarged prostate is benign (not cancerous) nor will it increase your risk of prostate cancer; for these reasons it is often referred to as benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy.
The exact cause of BPH is unknown; however, a common hypothesis points to changes in the balance of the sex hormones during the aging process. The testicles may also play an important role in prostate growth: for example, men who have had their testicles removed (i.e. as a result of testicular cancer) do not develop BPH. Furthermore, men who have their testicles removed after having developed BPH will experience a decrease in prostate size.
There are many treatment options available for BPH: medications, minimally-invasive procedures and surgery. What treatment option is best for you depends on your overall treatment goals, the size of your prostate, your symptoms, age and overall health. Make sure you speak with your doctor about the different treatment options; your doctor may recommend treatments based on your symptoms and treatment goals.
Medications
Prescription drugs are typically the first line of treatment for BPH. Alpha blockers are typically associated with high blood pressure, but in the case of BPH, act by relaxing the muscles in both the bladder neck and prostate, resulting in effortless urination. The effects of alpha blockers are typically seen very quickly (in about a day or two). 5 alpha reductase inhibitors reduce the size of the prostate, thus reducing the pressure on the urethra. Often, improvements are not seen for a couple of weeks or even months. Common side effects include decreased sex drive and impotence. Combination therapy of alpha blockers and 5 alpha reductase inhibitors can be more effective than either drug alone. Antibiotics may also be prescribed to treat prostatitis (prostate inflammation) which can accompany BPH.

Minimally Invasive Procedures
GreenLight Laser uses a high-powered laser combined with fiber optics to vaporize the overgrowth of prostate cells quickly and accurately. The heat of the laser also cauterizes blood vessels, resulting in minimal bleeding. It is an out-patient procedure that involves catheterization for about two days. Stents can be placed in the urethra to help keep it open and allow urine to flow easier. These stents must be replaced every four to six weeks, and as such, are not considered a long term treatment option.
Surgical Procedures
If medications are not effective, or if your prostate is too large, surgical intervention may be necessary. Transurethral resection of the prostate (TURP) involves the removal of portions of prostate which block urine flow. Hospital stay is typically one day with a two-day catheterization. Prostatectomy is the complete removal of the prostate gland. It is more invasive than TURP or GreenLight Laser, usually has a higher risk of complications and side effects and requires a longer catheterization. For these reasons, prostatectomies are typically reserved for those with unbearable BPH symptoms and those with extremely large prostates.




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Zytiga: A New Late-State Prostate Cancer Option

Written on 23 September 2011 by

On 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.




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Prostate Cancer Treatment: Match Between HIFU And Robotic Prostate Surgery And The Winner Is?

Written on 15 September 2011 by

The 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.




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Bone Scans and CT Scans for Prostate Cancer Patients

Written on 6 September 2011 by

As 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.




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Prostate Cancer Awareness Month Brings News of More Precise Prostate Cancer Screening on the Horizon

Written on 1 September 2011 by

Even 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.




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Prostate Cancer Urine Test on the Horizon

Written on 29 August 2011 by

There 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.




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Bone Scans and CT Scans for Prostate Cancer Patients

Written on 26 August 2011 by

As 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.




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