NEW YORK (Reuters Health) - Considering having a surgeon remove your cancerous prostate using a robot? You might want to see a surgeon who has done at least 80 operations for the best results, according to the authors of a new research review.
And while the robot-assisted operation is now the "dominant approach" to this surgery in the US and is gaining popularity in other wealthy nations, there's still too little information on how patients fare after the surgery, Dr. Declan G. Murphy of the Peter MacCallum Cancer Center in Melbourne, Australia and his colleagues write.
Laparoscopic surgery, in which a surgeon performs the operation through small incisions, usually with the help of a surgical robot, has been touted as carrying a lower risk of incontinence and impotence than the standard "open" form of the surgery.
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But a US study on nearly 9,000 men published in October 2009 found that while open and minimally invasive surgery were equally good for getting rid of prostate cancer, the risk of incontinence and impotence was higher with the minimally invasive approach.
In the current study, Murphy and his team looked at 68 studies of robot-assisted laparoscopic surgery to better understand its downsides. Lack of information on outcomes isn't only a problem for robot-assisted surgery, but "bedevils" the scientific literature on prostate removal overall, the researchers note in the journal European Urology.
In about one in 250 surgeries, the robot failed to work properly. There was also a lack of data on how well patients functioned after surgery, and how patients with high-risk prostate cancer fared long-term.
And while some studies showed low complication rates, the researchers add, those rates went up when doctors used a standardized approach to reporting complications. The authors did not compare robotic surgery complication rates to traditional surgery rates.
The researchers also found that surgeons who have done fewer than 20 of the robot-assisted procedures can achieve "acceptable operating times." Keeping surgeries shorter is a goal because it usually means fewer complications. It may be necessary, however, for surgeons to do 80 or more procedures to ensure that they do not leave cancerous tissue behind.
Also, the researchers add, robot-assisted surgery is no easier to perform and has no better outcomes in patients with conditions that can worsen surgical outcomes, such as being obese, having a large prostate, or having had previous surgery in the area.
Finally, the researchers note, expenses associated with the procedure--the robot costs at least 1.8 million ($2.6 million) to install, 100,000 ($145,000) a year to run, and 1,500 ($2,200) extra for each surgical case-mean the procedure is "prohibitively" expensive "for many hospitals and indeed many countries."
The researchers conclude: "The significant learning curve should not be understated, and the expense of this technology continues to restrict access to many patients."
SOURCE: European Association of Urology, online December 16, 2009
By Henry L. Davis
NEWS MEDICAL REPORTER
January 09, 2010, 6:26 AM
The National Comprehensive Cancer Network has announced that it has updated its practice guidelines for physicians to stress active surveillance rather than treatment for many men with low-risk prostate cancer.
Roswell Park Cancer Institute played a key role in the new recommendations, with three physicians serving on the network’s 23-member guideline panel, including Dr. James Mohler, who led the group.
A big change in the guidelines is the recommendation for active surveillance instead of treatment for men with very-low- risk prostate cancer and a life expectancy estimated at less than 20 years, and for men with low-risk prostate cancer and a life expectancy of less than 10 years. The very-low-risk category is new and represents patients with what’s considered “insignificant” prostate cancer.
The new guidelines reflect the debate in medical circles over what is the most appropriate action to take with early-stage prostate cancer.
The problem starts with the PSA test to detect prostate cancer. It can’t tell the difference between harmless tumors and those that will grow into dangerous cancers but has led to suspected tumors being diagnosed much earlier, leading many patients to rush into unnecessary therapies that drive up costs and risk complications.
The other dilemma for the 192,800 men who will be diagnosed with prostate cancer this year is that each therapy, such as surgery and radiation, has its advocates, as well as its pros and cons. But it’s unclear which one is best. The federal Agency for Healthcare Research and Quality in 2008 concluded that not enough scientific evidence exists to identify a treatment as most effective at prolonging life or limiting such side effects as incontinence.
Active surveillance is considered an option because prostate cancer is generally slow-growing. Experts estimate that 40 percent of patients 65 and older will die of other causes before their cancer requires treatment.
Active surveillance involves monitoring the disease and intervening if the cancer progresses. Patients in active surveillance should obtain regular prostate exams and PSA tests, according to the guidelines.
“Growing evidence suggests that overtreatment of prostate cancer commits too many men to side effects that outweigh a very small risk of prostate cancer death,” Mohler, chairman of urology at Roswell Park, said in a statement.
The National Comprehensive Cancer Network panel reviewed data showing that 23 percent to 42 percent of all prostate cancers detected in the United States by PSA tests and digital rectal exams are overtreated.
Despite the greater emphasis on active surveillance, Mohler said final decisions on care should be based on a careful review of a patient’s particular situation, including life expectancy, disease characteristics, general health condition, potential side effects of treatment and the patient’s preferences.
Drs. Robert Huben, chief of urology at Roswell Park, and Michael Kuettel, chairman of radiation medicine, also served on the panel.
The head of one of the leading prostate cancer advocacy groups praised the changes in the guidelines. “The recognition of active surveillance in recent years has been a good development,” said Thomas Kirk, president and chief executive officer of US TOO International, a network of more than 300 support groups around the world, including Buffalo. Source:http://www.buffalonews.com
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PHILADELPHIA, Jan. 8 (UPI) -- Sexual function in prostate cancer patients receiving beam radiation decreases within the first two years and then stabilizes, U.S. researchers found.
Researchers at the Jefferson Medical College of Thomas Jefferson University in Philadelphia, the Thomas Jefferson University Hospital in Philadelphia and University of California, Davis, School of Medicine evaluated 143 prostate cancer patients receiving external beam radiation therapy who completed baseline data on sexual function before treatment and at follow-up visits.
Senior author Dr. Richard Valicenti of the University of California, Davis, School of Medicine, said patients were analyzed on sexual drive, erectile function, ejaculatory function and overall satisfaction for a median time of about four years.
The study authors found the strongest predictor of sexual function after treatment was sexual function before treatment and the only statistically significant decrease in function occurred in the first two years after treatment -- and function then stabilized with no significant changes thereafter.
The findings are published in the International Journal of Radiation Oncology*Biology*Physics.
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NEW YORK (Reuters Health) - A healthy weight and regular exercise may help protect men from one of the most common side effects of prostate cancer surgery, a new study suggests.
Researchers found that among 165 men who had their prostate glands removed due to cancer, those who were not obese and were getting regular exercise before surgery had the lowest prevalence of long-term urinary incontinence.
What's more, even among obese men, those who had been physically active before surgery were less likely to be incontinent one year after surgery.
All of the men in the study had undergone radical prostatectomy, where a surgeon removes the prostate gland and some of the surrounding tissue. Urinary incontinence and sexual dysfunction are common side effects, though both often improve over time.
So far, most efforts to prevent lasting side effects have focused on improving surgical techniques -- limiting damage to the nerves, muscles and blood vessels around the prostate gland.
But these latest findings suggest that there are also lifestyle measures men can take to cut their risk of lingering urinary incontinence, said lead researcher Dr. Kathleen Y. Wolin, an assistant professor of surgery at Washington University School of Medicine in St. Louis.
"This is another reason for men to get up and get active," she told Reuters Health in an interview.
In general, men with prostate cancer, like all other men, are encouraged to follow a healthy lifestyle, which includes regular exercise. A study published last month found that among men with prostate cancer, those who got as little as 15 minutes of exercise per day had lower death rates than inactive men during the two-decade study period.
"We strongly recommend that men with prostate cancer talk with their physicians about how to fit physical activity into their lives if they are currently sedentary," Wolin said.
For their study, published in the Journal of Urology, Wolin and her colleagues looked at urinary incontinence rates among 165 men roughly one year after radical prostatectomy. Before surgery, all of the men had reported on their exercise habits; those who said they exercised for at least one hour per week were considered active.
Overall, the researchers found that obese, sedentary men had the highest rate of long-term incontinence, at 41 percent. Active, non-obese men had the lowest rate, at 16 percent.
Among obese men who were physically active, one-quarter were incontinent, which was identical to the rate among non-obese, inactive men -- suggesting, the researchers say, that exercise can offset the negative effects of obesity.
Exactly why exercise might prevent incontinence is unclear. One possibility, Wolin said, is that exercisers have better overall muscle tone, which may help with bladder control.
Another potential reason is that long-time exercisers are more likely to follow their doctors' advice on performing post-surgery Kegel exercises, which strengthen the pelvic-floor muscles and may improve incontinence and sexual function.
According to Wolin, more studies are needed to see whether certain types and intensities of exercise are more effective than others -- and how exercise habits after prostate surgery may affect long-term incontinence risk.
SOURCE: Journal of Urology, February 2010.
by the Cherokee Tribune staff
January 06, 2010
Southern Baptist Convention President Dr. Johnny Hunt of Towne Lake will undergo surgery today to remove a cancerous prostate.
The 57-year-old senior pastor of First Baptist Woodstock announced in November his prostate cancer diagnosis and plans to undergo initial treatment in January.
Jim Law, executive pastor of the church, said Hunt's surgery would be done at Northside Hospital in Atlanta.
"Dr. Hunt would like to thank so many churches and individuals who have interceded on his behalf these past few weeks," Law said in a statement released through the Baptist Press. "He is deeply grateful and has sensed the prayers and the love that has been demonstrated to him in so many ways by many Southern Baptist brothers and sisters."
Hunt and his wife, Janet, "have come to this decision after much prayer and seeking the Lord," Law said in the statement referring to the operation.
Hunt was elected the convention's president during its annual meeting in Indianapolis in June 2008. He was re-elected at the 2009 meeting in Louisville, Ky.
With 16.2 million members, the Nashville-based convention is the largest Protestant denomination in the U.S.
First Baptist Woodstock, which has more than 17,600 members, is Cherokee's largest church and the third-largest place of worship in metro Atlanta.
Reference: http://www.cherokeetribune.com
