Download Precise, Minimally Invasive Prostate Cancer

Precise, Minimally Invasive
Prostate Cancer Removal
Learn why da Vinci® Surgery may be your
best treatment option
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Beyond For
Minimally
Invasive
Prostate
Cancer
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Facing Prostate Cancer
Prostate cancer is among the most common cancers diagnosed in
men. In the US, one in six men will be diagnosed in their lifetimes.1
While no one will say that facing prostate cancer is easy, the good
news is that with increased awareness and screening, more men
are diagnosed early. Thus, most cancers are diagnosed while still
localized.
Treatment Options for Prostate Cancer
When prostate cancer is believed to be localized, there are five
common treatment options available to a patient:
1.Surgery to remove the cancerous prostate
(radical prostatectomy)
2.Radiation of the cancerous prostate, through either external radiation or radioactive seed implants (radiation therapy or brachytherapy, respectively)
3.Freezing of the cancerous prostate (cryotherapy)
4.Hormonal therapy, which is non-curative and often done in conjunction with radiation therapy or cryotherapy
5.Observation (watchful waiting)
Patients should discuss the advantages and disadvantages of each
treatment approach with their doctor.
For localized prostate cancer, radical prostatectomy has traditionally
been considered the definitive way to treat the cancer, by removing
it.2
This guide was designed to provide patients with information on
the surgical treatment of prostate cancer, which can be performed
in a very precise, minimally invasive manner using the da Vinci®
Surgical System.
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Surgery:
The Definitive Treatment for Prostate Cancer
“Because the entire prostate gland is removed with radical
prostatectomy, the major potential benefit of this procedure is
a cancer cure in patients in whom the prostate cancer is truly
localized.”2
- 2007 American Urological Association Clinical Guidelines
It is estimated that 91% of the prostate cancers diagnosed in the US
are clinically localized,2 which means that most men are potential
candidates for cancer removal.
Choosing Surgery: Patient Perspectives
James Porter, MD
da Vinci Surgeon and da Vinci Prostatectomy patient
“…We often see a lot more cancer in the prostate than we would have predicted based
on the biopsy. I knew with surgery that I was going to get the final word with regard to
how much cancer I had... I guess you could call it ‘the need to know.’”
Donald Sosin
da Vinci Prostatectomy patient
“You have a chance with this kind of surgery to get rid of the cancer... If I had to do it
again, I would do it again — except sooner.”
Visit www.daVinciStories.com for more perspectives on why
patients chose da Vinci Surgery to treat their prostate cancer.
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Surgery: Confidence in Knowing Your Status
Removing the cancerous prostate lets your doctor see the extent
and nature of the cancer. This step can be critical: In clinical studies,
up to 35% of tumors are undergraded; in other words, they are
more aggressive than the pre-surgery assessment and biopsy results
indicated.3
Margin status refers to whether or not there is cancer present at the
very edge (the margin) of the removed prostate gland. A negative
margin means that all edges of the prostate are free from cancer
cells. A negative margin is a good indicator that all of the cancer has
been removed.
Surgery: Preserving Your Options
Choosing surgery over radiation can make it easier for your doctor
to detect a cancer recurrence, through careful PSA* monitoring,
after a radical prostatectomy than after radiation therapy.4 It can
also help preserve your radiation treatment options if your cancer
returns. After radiation therapy, there may be damage to the tissue
surrounding the prostate. If you have tissue damage, nerve-sparing
surgery may no longer be an option should your cancer recur.
However, radiation usually remains an option for patients who have
had surgery to treat their prostate cancer.5
*PSA= Prostate-Specific Antigen, a protein that may indicate the presence of cancer.
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Long-Term Survival and Localized Prostate Cancer
With any cancer treatment, the first priority is survival. Several large
studies suggest that there is a greater chance of long-term survival
for patients undergoing surgery over other potential treatments.
15-Year Relative Risk of Death Lower with
Radical Prostatectomy than with Radiation
Cancer Specific
Mortality
Overall
Mortality
40%
38%
A study of 3,159 patients found that 15 years after treatment, those
who had undergone radical prostatectomy had a 40% lower risk of
death from prostate cancer than radiation patients.6
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Cancer Survival Comparison of Multiple
Treatment Methods
Cumulative Survival, %
1.0
0.8
Prostatectomy
Watchful waiting
Radiotherapy
Other therapy
0.6
Hormone therapy
0
1
2
3
4
5
6
7
8
9
10
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No. of Years After Diagnosis
In a study of 844 patients with localized prostate cancer, the
patients who had undergone prostatectomy showed a higher
prostate cancer survival rate than men choosing other treatments.7
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Precision with da Vinci Surgery
The da Vinci System provides your doctor with several clinical
advantages that can allow him or her to perform a more precise
surgery:
Precision
The da Vinci System’s tiny wristed instruments have an even
greater range of motion than the human hand. da Vinci seamlessly
filters any tremors from your surgeon’s hands and scales his or her
motions, translating them into more precise movements of the
instrument tips.
da Vinci Surgical System instruments are
approximately the diameter of a pencil.
Vision
High-definition 3D vision and 10x magnification enable your doctor
to see both the cancer and healthy tissues and blood vessels at a
level of detail far beyond what is possible with open surgery or
conventional laparoscopic surgery.
Control
The da Vinci System’s Intuitive® Motion provides control through an
interface that allows your doctor to use natural movements similar
to traditional surgery.
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Precision Matters:
Cancer Control
Bladder
Rectum
Urethra
Prostate
The prostate gland is attached to nerves, the rectum and the bladder.
The goal of nerve-sparing surgery is to maximize preservation of
important nerves, blood vessels and structures that control urinary
continence and sexual function, without compromising cancer control.
In Prostate Cancer Treatment, Precision Matters
In prostate cancer treatment, millimeters matter. Nerve fibers
and blood vessels are attached to the prostate gland. To spare
these nerves, they must be delicately separated from the
prostate before its removal. In comparison, radiation beam
treatment can vary by several millimeters. In one study of newer
radiation beam therapy the average variation of the beam
target was 3mm between sessions.8 This variation can cause
different amounts of radiation energy to be delivered to the
edges of the prostate where the nerves are located.
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Precision Matters:
Cancer Control
Surgeons use the precision, vision and control provided by the
da Vinci System to assist them in removal of the cancerous prostate
while preserving important nerves and blood vessels.
In several large published studies, da Vinci Prostatectomy has shown
equal or lower rates of positive surgical margins (the measurement
of cancer cells left behind) than large studies of other forms of
surgery.
Effective Cancer Control Shown with da Vinci
Surgery (T2 positive margins)
4.5%10
4.6%11
Study 2
Study 3
4.8%12
2.5%9
Study 1
Study 4
Cancer control is variable and based on each patient’s specific
cancer type. Surgeon experience is also an important factor. Talk
to your doctor about what your individual expectations should be
regarding cancer control.
Please visit www.daVinciProstatectomy.com for more cancer control
data.
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Precision Matters:
Urinary Symptoms
Studies have shown that patients who have undergone da Vinci
Prostatectomy may experience a faster return of urinary continence
following their surgery, compared with other surgical patients.
Surgery patients also report lower rates of urinary pain than
radiation (brachytherapy) patients.
Speed of Return to Urinary Continence
95%13
89.8%13
80%14
77%15
62%15
54%14
3 Months
6 Months
da Vinci Prostatectomy
Open Surgery
Laparoscopic Surgery
Increased Urinary Pain
63.7%16
19%16
18.4%16
Surgery
Radiation
9
2%16
2 Months
24 Months
Precision Matters:
Sexual Function
The prostate is surrounded by a delicate layer of nerves that support
erectile function. Many patients are candidates for a nerve-sparing
prostatectomy, where the prostate gland is removed but the
surgeon maximizes preservation of these nerves.
Return of sexual function at one year
79%17
81%18
Study 1
Study 2
87%19
Study 3
96%20
Study 4
Several studies have shown that patients potent prior to surgery
have experienced a high level of recovery of sexual function
(defined as an erection sufficient for intercourse) within a year
following da Vinci Surgery. Talk to your surgeon about reasonable
expectations for recovery of sexual function and ask about a
rehabilitation program that may include exercises and drug therapy.
Radiation and Sexual Function
Radiation can cause long-term damage to the nerves and important
structures involved in sexual function. Many patients undergoing
brachytherapy or external beam radiation treatment develop
erectile dysfunction (as many as 50% in several studies.)21, 22 Many
radiation patients
10 are also placed on hormone therapy, which can
have an immediate negative impact on sexual function.23
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da Vinci:
Get Back to Your Life
As a minimally invasive treatment, da Vinci Surgery for prostate
cancer offers numerous potential benefits compared to traditional
open surgery. Using da Vinci, surgeons operate through tiny 5-12mm
incisions — which is roughly the diameter of a pencil.
Potential benefits include:
Shorter hospital stay24
Significantly less pain25
Less blood loss and fewer transfusions26
Less scarring
Faster return to normal activities27
Open Surgical Incision
da Vinci Prostatectomy Incision
Learn more at www.davinciprostatectomy.com
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da Vinci Surgery:
Beyond Minimally Invasive Surgery
With the added precision, vision and control provided by the
da Vinci System, your surgeon can offer you the gold standard
treatment — surgery — with all the potential benefits of a
minimally invasive procedure.
da Vinci Surgery provides a minimally invasive approach while
preserving the potential outcome benefits of traditional open
surgery. Its exceptional precision can provide you with effective
cancer removal, as well as a better chance of preserving delicate
nerve structures responsible for sexual function and urinary
continence, as compared with traditional surgery or radiation.
In summary, da Vinci Surgery can help to put cancer behind you so
you can get back to your life as quickly as possible.
Important Considerations with da Vinci Prostatectomy
While clinical studies support the use of the da Vinci Surgical
System as an effective tool for minimally invasive surgery, individual
results may vary. da Vinci Prostatectomy is a surgical procedure,
and all surgery carries inherent risks. Though data suggests that
da Vinci Surgery can provide excellent cancer control, faster return
to sexual function and to urinary continence as compared with
other treatment options, all prostate cancer treatments, including
surgery, can increase risk of incontinence and/or urinary symptoms
and impotence. Additionally, there is no guarantee of the benefits
described for every patient. For example, some individuals may
not be candidates for a full nerve-sparing procedure due to the
extent of their cancer. And as with any surgical treatment, results
of da Vinci Surgery are in part surgeon-dependent and can improve
significantly with surgeon experience.
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Clinical References
http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.70619/k.446E/Risk_Factors.htm.
2
Prostate cancer clinical guideline update panel. Guideline for the management of clinically localized prostate cancer: 2007 update. Linthicum (MD): American
Urological Association Education and Research, Inc. 2007; 82.
3
King CR, Patterns of prostate cancer biopsy grading: trends and clinical implications. Int J. Cancer (Radiat. Oncol. Invest.) 2000; 90,305-311.
4
Di Blasio, C. J., A. C. Rhee, et al. Predicting clinical end points: treatment nomograms in prostate cancer. Semin Oncol. 2005; 30(5):567-86.
5
Carlucci JR, Nabizada-Pace F, Samadi DB. Organ-confined prostate cancer and the emergence of robotic prostatectomy: What primary care physicians and
geriatricians need to know. Geriatrics. 2009; 64(2):8-14.
6
Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either
conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec; 68(6):1268-74.
7
Merglen A, et al. Short- and long-term mortality with localized prostate cancer. Arch Intern Med 2007; 167:1944-1950.
8
Boda-Heggemann J, Kohler FM, Wertz H, et al. Intrafraction motion of the prostate during an IMRT session: a fiducial-based 3D measurement with Cone-beam
CT. Radiat Oncol. 2008 Nov 5; 3(1):37.
9
Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May; 99(5):1109-12.
10
Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes.
Urology. 2004 May; 63(5):819-22.
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Kaul, S, A Savera, K Badani, M Fumo, A Bhandari, M Menon. Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of
Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int. 2006; 97:467-72.
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Tewari et al. Total reconstruction of the vesico-urethral junction, BJU international. 2008; 101, 871–877.
13
Patel VR, Thaly R, Shah K. Robotic radical prostatectomy: outcomes of 500 cases. BJU Int. 2007 May; 99(5):1109-12.
14
Walsh PC. Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. J Urol. 2000 Jul; 164(1):242, 59.
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Goeman L., Salomon L., La De Taille A, et al. Long-term functional and oncological results after retroperitoneal laparoscopic prostatectomy according to a
prospective evaluation of 550 patients. World J Urol. 2006; 24, 281-288
16
Buron C, Le Vu B, et al. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study. Int
J Radiat Oncol Biol Phys. 2007; 67(3):812-22.
17
Badani KK, Kaul S, Menon M. Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer. 2007 Sep; 24;110(9):1951-1958.
18
Mottrie A, Van MP, De NG, Schatteman P, Carpentier P, et al. Robot-assisted laparoscopic radical prostatectomy: oncologic and functional results of 184
cases. Eur Urol. 2007; 52:746–51.
19
Mikhail A, et al. Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology. 2006; 67(4): 774-9.
20
Kaul S, Savera A, Badani K, Fumo M, Bhandari A, Menon M. Functional outcomes and oncological efficacy of Vattikuti Institute prostatectomy with Veil of
Aphrodite nerve-sparing: an analysis of 154 consecutive patients. BJU Int. 2006; 97:467-72.
21
Zelefsky M, Chan H, Hunt M, Yamada Y, Shippy A, Amols H. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically
localized prostate cancer. journal of urology.2006; 176 (4): 1415-1419 .
22
Merrick G. Erectile function after prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2005 Jun; 62(2): 437-47.
23
Sharifi N, Gulley J, and Dahut W. Androgen deprivation therapy for prostate cancer. JAMA. 2005 Jul; 294(2): 238 - 244.
24
Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes.
Urology. 2004 May;63(5): 819-22.
25
Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic
prostatectomy: the Vattikuti Urology Institute experience. J Urol. 2003 Jul;170(1):318-9.
26
Boris RS, Kaul SA, Sarle RC, Stricker HJ. Radical prostatectomy: a single surgeon comparison of retropubic, perineal, and robotic approaches. Can J Urol. 2007
Jun;14(3):3566-70.
27
Miller J, Smith A, Kouba E, Wallin E, Pruthi R. Prospective evaluation of short-term impact and recovery of health-related quality of life in men undergoing
robotic-assisted laparoscopic radical prostatectomy versus open radical prostatectomy. J Urol. 2007 Jul; 178 (3 pt 1): 854-859
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While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery
with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their
risks and benefits. © 2009 Intuitive Surgical. All rights reserved. Intuitive, Intuitive Surgical, da Vinci, da Vinci S and EndoWrist are trademarks or
registered trademarks of Intuitive Surgical. PN 870298 Rev. B 5/09
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For more information about
da Vinci Prostate Cancer Surgery visit:
www.daVinciProstatectomy.com
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