Robotic Surgery for Complex Prostate Cancer

July 31, 2018 | by Kevin Chesley

Nearly 164,690 men are diagnosed with cancer of the prostate gland every year.
If it is detected early and hasn’t spread, prostate cancer is survivable — especially with the use of robotic-assisted prostatectomies.
Since 2003, the City of Hope team has performed thousands of these surgeries — more than any other medical facility in the western U.S. One vital member of that team is Bertram Yuh, M.D., an associate clinical professor in the Division of Urology and Urologic Oncology in the Department of Surgery at City of Hope. He went over some of the latest tactics in the battle against prostate cancer.

Levels of Aggressiveness

Assessing the stage of each patient’s cancer is vital when deciding on treatment options. Advanced or aggressive cases are fought in very different ways from those caught early.
"We want to look at the big picture in a specific patient, especially with prostate cancer presentations evolving,” Yuh says.
We determine whether a cancer is aggressive or less aggressive by combining a patient’s history with biopsy results, imaging, blood tests and genetic profiling. City of Hope is well-equipped to address even aggressive cancers that are more bulky, invade surrounding structures and have an overall higher complexity for the surgeon.”

Benefits of Robotic Surgery

City of Hope is experienced in all methods of treatment, including robotic surgery. “Essentially all of our surgeries are performed robotically,” Yuh says. “We have pioneered these technologies and techniques for over a decade. Effective long-term results have been shown through our data and patient experiences.”
Yuh cites added benefits to surgery as well: “We believe that surgical treatment, in the case of an aggressive prostate cancer, can be an excellent step not just for effective cancer control, but as a means of understanding more about a specific cancer, in particular of the staging. During an operation, we are much better able to assess the local extent of cancer, as well as whether cancer has gone to lymph nodes. Surgery is also an excellent first step for men who require multimodal — or a multiple treatment approach — when addressing their cancer.”

Detection at a Microscopic Level

Before surgery begins, computed tomography scans, bone scans, positron emission tomography scans and magnetic resonance imaging assess whether cancer has spread beyond the prostate. But Yuh takes the search further. “Many patients can have microscopic disease that spreads to lymph nodes or other parts of the body that may not be detected through traditional imaging modalities,” he says. “During robotic operations to the prostate, we remove a large number of lymph nodes to provide a detailed prognosis and understand whether additional treatments are necessary."
Should those additional treatments be needed, there are many options including radiation, medication, hormone treatments and chemotherapy agents. New promising treatments, such as immunotherapies including vaccines, are in clinical trials.

Hope in Battling Side Effects

All methods of fighting cancer, however, come with side effects. Surgery, in particular, is known to carry risk factors such as incontinence and erectile dysfunction.
Yuh sees a potential for robots to help. “One way that we’re trying to reduce the side effects profile is by better understanding the anatomy of nerves in the pelvis that run along the prostate,” he says. “We see these nerve bundles better using a robotic procedure and some intraoperative techniques using fluorescent imaging and antibodies. These help us better identify where the nerve tissues important to functional outcomes may be and do a more precise operation that removes the cancer while sparing those areas important for functional control.”
Though side effects are a risk, Yuh encourages men with prostate cancer to study all of their options. “Traditional thinking may have made surgical treatments less desirable but, with the latest improvements in technique and technology, it may be the optimal option to consider,” he says. 

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