By Mary Minor Davis
Robotics Improving Outcomes for Prostate Cancer
Prostate cancer is the second most common cancer among American men, behind skin cancer, according to most research. And in many cases, treatment can lead to successful outcomes, allowing men to lead normal lives.
The University of Arizona’s College of Medicine and the Department of Urology at Banner University Medical Center – Tucson would like to see survival outcomes increase even more.
The newest era in the treatment of prostate cancer could be just around the corner. The UA is now working with SWOG Cancer Research Network (formerly Southwest Oncology Group), a National Cancer Institute-supported clinical trial cooperative. They recently launched a research trial that examines men who have metastatic prostate cancer. The research will look at the efficacy of treating men with both surgical removal of the prostate paired with chemotherapy.
Dr. Benjamin R. Lee, a professor and chair of the Department of Urology at the UA College of Medicine, shared the latest efforts in both robotics “and a new clinical trial that hopes to offer even higher survival rates for patients diagnosed with prostate cancer.” To understand where prostate cancer treatment is today, Lee said it is necessary to understand where treatment was just over 20 years ago.
“Historically, men would be diagnosed very late after the cancer had metastasized into the lymph nodes or the spine. The only treatment option was radiation,” Lee said. “This often led to renal failure from the cancer blocking the kidneys. If cancer had metastasized to other areas, men could only undergo hormone therapy, which essentially blocked testosterone and was a type of chemical castration.”
In 1996, the Prostate-Specific Antigen – or PSA – test was approved to help detect early signs of prostate cancer. This was a game changer, Lee said. An elevated PSA reading of 4.0 or higher indicates a high risk of abnormalities and can be addressed before the cancer advances.
Further, it allows the care team to assess the risks – how aggressive the cancer might be, health risk factors and overall quality of life. This then determines treatment, which can range from “active surveillance” to removal of the prostate with robotic surgery to radiation. Active surveillance is typically offered in “low risk” disease, where the cancer may not be aggressive. The cancer is carefully monitored by the patient’s care team through regular testing of the PSA.
Around the same time the PSA became the go-to test, the first robotic surgical procedure to remove the prostate occurred. Today, Lee says robotic surgery is the norm for the many benefits it brings to the patient, including smaller incisions, much less blood loss and faster recovery.
“Prostate surgery is a very delicate process,” Lee said. “The prostate has to be separated from the bladder, and then nerves that allow men to maintain potency are dissected free from the prostate and the dorsal vein is tied to reduce blood loss. The precision in robotic surgery is immensely beneficial.” He added that with robotics, he can complete the entire surgery in just under 90 minutes.
“There is also a measurable difference in the amount of blood loss,” Lee said. “In open surgery, blood loss is between 800 to 1,000 ml (milliliters). With robotics, that is greatly reduced to 150 to 200 mls. That’s significant.”
Most importantly, Lee said, “With the more advanced stages of cancer, robotics allows for greater chance of survival.”
Recently, the Arizona Board of Regents approved the Division of Urology to be a stand-alone department, a move that Lee said is important as it recognizes the work being done by the urology team. It will also mean growth for the department, access to more research opportunities, fellowships and grants.
“For us, the basic question is: When a man walks through our door, how do we know he will die of his prostate cancer or live with his prostate cancer? We’ve had some exciting research developments and revolutionary success with robotics. Our goal is to maintain the highest quality of a man’s life possible.”