Clinically localized prostate cancer: Prostatectomy

1
Clinically localized prostate cancer
Prostatectomy

• David D. Thiel, MD
• Mayo Clinic Florida
• Department of Urology

2
Prostate Cancer in PerspectiveEstimated
risk per 1,000 men
3
Cancer Deaths, U.S.
Prostate

Decrease 33 12
4
Prostate Cancer Therapy Goals

• Eradicate Cancer
• Preserve Continence
• Prevent Regret
• Preserve Erections

Quality of Life
5
Prostate Cancer Options

• Watchful waiting
• Active surveillance
• Surgery
• Retropubic
• Perineal
• Robotic
• Radiation Therapy
• External beam
• Brachytherapy
• Proton Beam

• Cryotherapy
• HIFU
• Cyber knife
• Androgen deprivation (ADT)

6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
Da Vinci

• Fred Moll (surgeon) approached by SRI
  international
• Develop Field Robot for wounded soldiers
• Too expensive and not practical
• Together with engingeers and Venture Cap money
  Started Intuitive Corp.

12

• 127 Million in Venture cap money
• 1999 posted 18.4 million loss
• Marketed for Gall Bladders
• 2000 prospectus made no mention of prostate
  surgery

13
(No Transcript)
14
General Numbers

• 8000 RALP in 2004
• 10-17 of prostates in 2006 RALP
• 80 in 2009
• - Contemp Urology 2007 19(2).
• - J Endourology 2006 20(11).

15
da Vinci Surgical System
16
da Vinci System Console
17
Hand controls
18
Five degrees of Freedom
19
(No Transcript)
20
(No Transcript)
21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
Patient Positioning
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
(No Transcript)
32
Operative Data

• Blood Transfusion lt 1
• Conversion to open lt 1
• Rectal injury lt 0.1
• Deaths 0

33
QOL data

• Incontinence lt 1
• Erections long talk
• Best treatment to preserve long term erections

34
Reasons for young men to have prosatectomy(What
is young?)

• 1. Potential voiding dysfunction
• 2. Adjuvant therapy if failure
• 3. Secondary malignancy

35
ProstatectomyNon-debatable disadvantages

• 100 ejaculatory failure
• Possible blood transfusion
• 0.03 surgical mortality
• Surgical risk
• Infx
• PE
• MI
• Etc.

36
ProstatectomyNon-debatable advantages

• Definitive staging
• Pt cured if tumor pathologically confined
• Tx simultaneous LUTS/BPH
• Easy monitoring
• Decrease PSA anxiety over follow-up